North East LHIN Board Package. Board of Directors Meeting Teleconference

Transcription

1 North East LHIN Board Package Board of Directors Meeting Teleconference Thursday, August 22, 2013

2 Board of Directors Meeting August 22, 2013 North East Local Health Integration Network Board of Directors Meeting Thursday, August :30-4:30 p.m. Teleconference PUBLIC: PASSCODE: (Board Directors and Senior Directors must identify themselves as a GUEST SPEAKER) NOTE: DIRECTORS ARE REQUESTED TO NOTIFY THE CHAIR PRIOR TO THE COMMENCEMENT OF THE BOARD MEETING WITH RESPECT TO POTENTIAL CONFLICTS OF INTEREST ARISING FROM ITEMS ON THE AGENDA. Item No. Topic Lead Proposed Outcome Page No. Board of Directors Meeting Regular Session min Call to Order: Introductions of Elaine Pitcher attendees in person and via teleconference line min Declaration of Conflict of Interest Elaine Pitcher min Approval of Agenda Elaine Pitcher D min If there are no items requiring removal into regular agenda, motion to approve consent agenda Elaine Pitcher D 5 Consent Agenda: Any Board Director may request that an item or items be removed from this consent agenda and moved to the regular agenda 5.0 Board Attendance Elaine Pitcher I Approval of Minutes of past Board meeting of June 27, 2013 Regular Agenda 7.0 Business arising from previous meetings CEO Performance Evaluation Memo Ministry-LHIN Joint Advisory Committee (MLPA) min Report from the Chair Anson General Hospital Board Recruitment Update Elaine Pitcher D 7 Elaine Pitcher Martha Auchinleck (acting CEO) I Elaine Pitcher I 80

3 Board of Directors Meeting August 22, min Report from Audit Committee Dr. Colin Germond I min Report from Governance Committee Danielle Bélanger- Corbin I 11.0 Report from the Chief Executive Officer and Senior Management: min min min min Q1 Report for Hospital Working Funds Initiative SAH TADH Notice of Intended Integration NESGS and NBRHC Rockhaven Recovery, Iris Addiction Recovery for Women and Salvation Army H-SAA Extention North Bay Regional Health Centre FLS Designation Martha Auchinleck (acting CEO) Kate Fyfe D 148 Martha Auchinleck (acting CEO) Martha Auchinleck (acting CEO) Martha Auchinleck (acting CEO) D D 188 D min WAHA Stage 1 Capital Proposal Martha Auchinleck (acting CEO) D min Physio Update Terry Tillezek I min Next Meeting: Elaine Pitcher I September 26 th 2013 (Audit and Governance Committee Meetings) October 24 th 2013 (Board Meeting in person in Sudbury, *Note from Lynn) min Adjournment of Board Meeting Elaine Pitcher D 210 D=Decision, I=Information

4 Resolution North East Local Health Integration Network (the Corporation ) Motion No.: 2013-BD0014 Moved by: Seconded by: Thursday, August 22, 2013 RESOLVED THAT: The agenda for the North East LHIN Board of Directors meeting of August 22, 2013, be approved as presented. Elaine Pitcher Chair 4

5 Resolution North East Local Health Integration Network (the Corporation ) Motion No.: 2013-BD0015 Moved by: Seconded by: Thursday, August 22, 2013 RESOLVED THAT: The Consent Agenda for the North East LHIN Board of Directors meeting of August 22, 2013, be approved as presented including: Approval of the June 27, 2013 NE LHIN Board of Directors Meeting minutes Elaine Pitcher Chair 5

6 LEGEND 2013 BOARD OF DIRECTORS MEETING ATTENDANCE North East Local Health Integration Network * Meeting held via teleconference FF Director attended meeting in person TC Director attended meeting via teleconference VC Director attended meeting via videoconference N/A Director was entirely absent from meeting No longer a Board Director Members of the Board of Directors January 24 Sudbury March 28 Sudbury May 23 TC June 27 SSM Elaine Pitcher, Board Chair VC TC TC FF Dr. Colin Germond FF FF TC FF Danielle Bélanger-Corbin FF TC FF Santina Marasco FF FF TC FF Cecilia Bruno TC FF Dr. Ian Cowan FF N/A August 22 TC October 24 Sudbury Members of the Board of Directors Audit Committee February 28 April 25 May 23 September 26 November 28 Dr. Colin Germond, Chair FF FF TC Elaine Pitcher TC TC TC Danielle Bélanger-Corbin TC TC Cecilia Bruno Santina Marasco FF FF TC Members of the Board of Directors Governance Committee February 28 April 25 September 26 November 28 Danielle Bélanger-Corbin, Chair TC TC Elaine Pitcher TC TC Dr. Colin Germond FF FF Cecilia Bruno Santina Marasco FF FF 6

7 NE LHIN Board of Directors Minutes of Proceedings June 27, 2013 NORTH EAST LOCAL HEALTH INTEGRATION NETWORK BOARD OF DIRECTORS Algoma s Water Tower Inn, Sault Ste Marie 8:30 a.m. MINUTES OF PROCEEDINGS Thursday, June 27, 2013 CALL TO ORDER Chair Elaine Pitcher called the meeting to order at 8:33 p.m. ROLL CALL Members participating Staff: Elaine Pitcher, Chair Dr. Colin Germond Santina Marasco Danielle Belanger-Corbin Cecilia Bruno Louise Paquette, Chief Executive Officer Martha Auchinleck, Senior Director Kate Fyfe, Senior Director Terry Tilleczek, Senior Director (via phone) Tamara Shewciw, Chief Information Officer Cynthia Stables, Director (via phone) Lara Bradley, Communication Officer Guest Speakers Paul Heinrich David Smits Nancy Jacko Phil Geden Karen Bennett Gary Jodouin David McNeil Ben Peterson Participants on the line: Jim Hanna, West Parry Sound Health Centre WELCOME AND INTRODUCTION Elaine welcomed Board members, staff and guests to the NE LHIN Board Meeting in her home town of Sault Ste Marie. Page 1 of 5 7

8 NE LHIN Board of Directors Minutes of Proceedings June 27, 2013 DECLARATION OF CONFLICT OF INTEREST Danielle raised a potential conflict with the Great Northern Family Health Team submission as her husband is employed there. She offered to leave the room during the discussion AGENDA {Motion 2013-BD010} Moved by Cecilia Bruno, seconded by Colin Germond. That the agenda for the Board of Directors meeting of Thursday, June 27, 2013 be approved as amended. {Carried} {Motion 2013-BD011} Moved by Santina Marasco, seconded by Danielle Belanger-Corbin. That the consent agenda for the Board of Directors meeting of Thursday, May 23, 2013 be approved as presented including: Approval of the May 23, 2013 NE LHIN, Board of Directors Meeting Minutes Approval of the Declaration of Compliance for the First Quarter {Carried} BUSINESS ARISING: HSN Peer Review, Louise Paquette The NE LHIN senior team met with HSN senior team to go over the implementation of the recommendations of the Peer Review. The LHIN is pleased to see that HSN has acted on the recommendations and that implementation is having a significant impact on improving hospital processes. UPDATE FROM THE CHAIR: Elaine Pitcher The Algoma Anchor Agency Elaine and LHIN staff had two meetings in June with providers who had signed the Section 27 forms, other providers who were contemplating integrating, and also with Anchor Agency staff and board members. Some good discussion transpired on the role of the Anchor Agency moving forward and while some of the health service providers are ready to move faster than others, the meetings ended with agreement that moving forward in the best interest of more coordinated care in the area was the comment goal. The CEO of the Anchor Agency agreed to work with the LHIN and providers in the Algoma Area to identify areas that could be worked on in 2013/14 that would improve the services in Algoma. HOSPITAL IMPROVEMENT PLANS (HIPs) North Bay Regional Health Centre (NBRHC) CEO Paul Heinrich, accompanied by senior staff and Board members were present for the presentation on NBRHC s strategies to achieve a balanced financial position. Key to creating their HIP has been Page 2 of 5 8

9 NE LHIN Board of Directors Minutes of Proceedings June 27, 2013 engagement of staff at all levels from the front line to senior management. The hospital has been transparent with the union on all aspects of its finances. LEAN methodologies have also been adopted to find efficiencies and receive input from staff. The Board congratulated the hospital on its thoroughness and staff engagement in creating its HIP. Paul asked for the NE LHIN to continue supporting NBRHC s dialogue with the Ministry over funding models given its unique mandate to provide Mental Health services across the region. Elaine said the LHIN wants its hospitals to be as successful as possible and the LHIN will continue conversations with the Ministry to this effect. Health Sciences North Ben Peterson and David McNeil were present for the HSN presentation. During their presentation, it was noted that if the hospital wants to qualify for working funds relief it needs to achieve a small surplus and demonstrate it can create and follow a sustainable plan. Last year, HSN did not quality for working funds relief in 2011/12 because it did not achieve a balanced budget. The good news was that the hospital did achieve a balanced operating position for the 2012/13 year. Elaine congratulated the hospital on its adoption of the Peer Reviewer s recommendations and the beneficial impact it has had on HSN. She asked if the hospital has engaged its surgeons and physicians in creating its HIP, given that further to recent media coverage and a recent meeting she had with them, it wasn t clear that they had a full understanding of the financial process for hospitals. Ben and David noted that a continuous dialogue with the surgeons is ongoing. Louise asked that the hospital provide the LHIN with areas where demand for services have increased and wait-times have increased, further to the media coverage regarding clinical programs being cut despite increase usage. Elaine asked whether the clinical leadership of HSN engages with physicians in other hub hospitals, as part of their role as a regional hospital. David replied that this is only happening at the Chief of Staff level. Elaine urged the hospital to encourage these collaborations/discussions with colleagues in other Northeastern Ontario hospitals as they might prove beneficial in sharing best practices and solutions. The Board thanked the hospital for putting together a comprehensive plan. {Motion 2013-BD012} Moved by Santina Marasco, seconded by Cecilia Bruno. That the Board accept and approve North Bay Regional Health Centre s Hospital Improvement Plan as presented on June 27, {Carried} {Motion 2013-BD013} Moved by Colin Germond, seconded by Danielle Belanger-Corbin That the Board accept and approve Health Sciences North s Hospital Improvement Plan as presented on June 27, {Carried} PRE-CAPITAL SUBMISSION BY TEMISKAMING HOSPITAL FOR SPACE TO HOUSE THE GREAT NORTHERN FAMILY HEALTH TEAM Martha Auchinleck Board Director Danielle Belanger-Corbin left the room during the discussion and decision made on this item. Page 3 of 5 9

10 NE LHIN Board of Directors Minutes of Proceedings June 27, 2013 A space formerly occupied by the Public Health Unit has become available at the hospital. A proposal is put forward to adapt the space so that the Family Health Team can move into it The hospital is not asking for funding from the LHIN only support for its proposal. The Board asked whether the space is viable, to which Martha replied it is. Questions were also raised regarding how the physicians would finance this move and Martha replied that the she has been advised that the financing is in place. {Motion 2013-BD014} Moved by Cecilia Bruno, seconded by Santina Marasco WHEREAS: The cost estimate to be paid by the GNFHT is $918,284.The Ministry of Health and Long Term Care will fund 60% of the renovations and the additional 40% will be covered by various funding sources such as the Northern Ontario School of Medicine (NOSM), the City of Temiskaming Shores, the GNFHT physicians and other community funding sources. AND WHEREAS: The colocation of the GNFHT with the Temiskaming Hospital will support the ongoing recruitment and retention of physicians and allied health care providers in the area and will create opportunities for partnerships to improve client services. The North East LHIN Board of Directors supports the Pre-Capital Submission for the Temiskaming Hospital as presented on June 27, 2013 to renovate vacant space at the hospital to accommodate the Great Northern Family Health Team (GNFHT) and eight physicians. (carried) FIRST QUARTER REPORT Kate Fyfe The LHIN is on track to a balanced budget this fiscal. Danielle raised concerns over the growing working capital debt incurred by many of the small hospitals. Many are using working capital as a way to reduce their deficits, which is not sustainable for the hospitals or the system over the long term. After a discussion ensued, the Board decided that it should approach this issue and engage with hsps governance leaders through a communique this fall. NEXT MEETING The next scheduled Board of Directors meeting will take place on August 22, 2013 by teleconference CEO PERFORMANCE EVALUATION Louise provided a revised performance evaluation document based on Board feedback of April 25 th to be used in evaluating her performance. Elaine will follow up with Board members. ADJOURNMENT OF THE BOARD MEETING {Motion 2013-BD0015} Moved by Danielle Belanger-Corbin, seconded by Colin Germond Be it resolved that the Regular Board of Directors meeting of Thursday, June 27, 2013 be adjourned at 10:10 a.m. {Carried} Page 4 of 5 10

11 NE LHIN Board of Directors Minutes of Proceedings June 27, 2013 Elaine Pitcher Chair Page 5 of 5 11

12 North East Local Health Integration Network Chief Executive Officer PERFORMANCE ASSESSMENT Board Member BACKGROUND AND INSTRUCTIONS The attached questionnaire asks you to provide input on your perception of how the CEO performs her functions. The view is from a governance perspective and thereby relates to your exposure to the CEO at Board and committee meetings, the media and other Board-CEO interactions. Please provide a rating for each question and category by placing an X in the appropriate box opposite the question and please feel free to add any comments in the space provided that you feel will be helpful to amplify your rating. Please complete this questionnaire no later DATE. You can complete your questionnaire electronically and to name of person ( name@ .com or return to her by mail (self-stamped envelope attached). Name will tabulate the results on behalf of the Board of Directors. It is important that EVERYONE completes the questionnaire, so indicating your name on page 10 is important. Only Name of person will see the individual questionnaires and will treat them in utmost confidence. 12

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14 1. Board Relations CEO: 1. Demonstrates the ability and willingness to establish meaningful goals with the Board and to openly discuss performance-what is going well and where further effort is needed. Needs Improvement Meets Expectations Exceeds Expectations Not Able to Evaluate 2. Supports the board and works collaboratively to broaden the Board s knowledge so that they have the ability to assist in developing thorough and practical recommendations and plans for the LHIN and community. 3. Keeps the Board updated with relevant information and feedback from the community so that the Board feels that it is in touch with the range of community needs. 4. Works to bring new Board members up to speed quickly so they can be strong contributors. OVERALL RATING (Board Relations): Comments: 2. People Leadership 3 14

15 CEO: 5. Builds organizational spirit, constantly acting as a strong supporter and ambassador for the LHIN. Needs Improvement Meets Expectations Exceeds Expectations Not Able to Evaluate 6. Demonstrates understanding of interpersonal and team dynamics and can work with others under a variety of circumstances to achieve desired results. 7. Demonstrates effective planning and organizing of work and is effective at getting work completed through others-delegating and providing guidance. 8. Demonstrates an ability to make her point effectively and maintain an effective interpersonal atmosphere even when there are conflicting points of view with CEO peers, staff or external colleagues. 9. Demonstrates a commitment to personal learning and selfimprovement after receiving feedback; provides feedback to others and supports their development activity. 10. Ensures that an effective executive team is in place, functioning with an appropriate organizational structure. OVERALL RATING (People Leadership): Comments: 4 15

16 3. Initiative CEO: 11. Demonstrates calmness under fire resolving difficult situations with courage and respectfulness of others points of view. Needs Improvement Meets Expectations Exceeds Expectations Not Able to Evaluate 12. Demonstrates mental toughness and is highly proficient and creative in solving tough problems and managing the demands of multiple stakeholders. 13. Demonstrates a strong results orientation and always delivers results, adapting to changing circumstances as necessary. 14. Demonstrates a positive perspective and can-do attitude maintaining an upbeat outlook which has a positive impact on others. 15. Demonstrates initiative; is a selfstarter and knows when and how to take action in an ambiguous environment. OVERALL RATING (Initiative): Comments: 5 16

17 4. Knowledge CEO: 16. Demonstrates health service knowledge; understands and presents to others how the work of the LHIN will clearly contribute to the Ministry s vision for health care. Needs Improvement Meets Expectations Exceeds Expectations Not Able to Evaluate 17. Demonstrates the ability to think strategically and understands the long-term implications of decisions. 18. Demonstrates sound judgmentunderstands the implications of decisions and shows strong judgment and courage in difficult situations. 19. Demonstrates critical thinking skills; can zero in on the opportunities and risks in discussion with major stakeholders; gathers information and input and translates into potential solutions. 20. Demonstrates the discipline to stay up to date with all Ministry and stakeholder information and incorporates this information into planning activities. OVERALL RATING (Knowledge): Comments: 5 17

18 5. Communications CEO: 21. Demonstrates an interest in others points of view; listens intently and considers what they have said with her responses. Needs Improvement Meets Expectations Exceeds Expectations Not Able to Evaluate 22. Demonstrates adaptability and flexibility so that his communication and leadership style matches that of different people or different situations. 23. Communicates openly and honestly with the Board and individual board members. 24. Expresses ideas clearly, persuasively and effectively. OVERALL RATING (Communications): Comments: 7 18

19 6. Accountability CEO: 25. Develops and recommends an appropriate annual operating plan and budget for Board consideration. Needs Improvement Meets Expectations Exceeds Expectations Not Able to Evaluate 26. Ensures that LHIN resources are managed effectively (financial, real estate, technology, human resources). 27. Monthly reports to the Board are accurate and comprehensive 28. Advises Board promptly of areas that may be off budget. 29. Demonstrates clarity around the development of a performance measurement framework for the Champlain LHIN. OVERALL RATING (Accountability): Comments: 8 19

20 7. External Relations CEO: 30. Demonstrates the ability to persuade others and sells the LHIN concept to stakeholders in order to get their support and endorsement. Needs Improvement Meets Expectations Exceeds Expectations Not Able to Evaluate 31. Demonstrates a willingness and ability to work collaboratively across all stakeholder groups to produce thinking and generate discussion that is more integrative; brings together disparate groups to generate action and sustain momentum once it has been established. 32. Demonstrates the ability to clearly communicate the positive role of the LHIN in the future of Ontario s health services delivery vision in order to build stakeholder relationships for the longer term. 33. Communicates effectively with the media and the public. 34. Maintains effective working relationships with appropriate provincial government departments and agencies. OVERALL RATING (External Relations): Comments: 9 20

21 8. Strategy CEO: 35. Ensures that there has been effective stakeholder input to the development of the HISP. Needs Improvement Meets Expectations Exceeds Expectations Not Able to Evaluate 36. The project plan for the IHSP is effectively presented and approved by the Board. 37. Ensures that progress towards the IHSP is monitored and reported to the Board on a periodic basis. 38. Ensures that there is community awareness of the IHSP and its progress. OVERALL RATING (Strategy): Comments: 10 21

22 Please provide your comments on the overall performance of the Chief Executive Officer. 1. What would you say are her two or three greatest strengths as the CEO of the LHIN? 2. What would you say are two or three greatest development needs as the CEO of the LHIN? (areas for improvement) 3. Please add any additional comments on the overall performance of the CEO COMPLETED BY: (Your Name) Thank you for taking the time to complete this assessment! 11 22

23 Overview of Ministry-LHIN Performance Agreement ( ) May

24 Briefing Objectives To provide an overview of the key changes to the Ministry-LHIN Performance Agreement (MLPA) ( ) and their implications for the LHINs and the ministry. To provide detail in the Appendices regarding: o o o o o Agreement timelines Ministry-LHIN Joint Advisory Committee (JAC) membership MLPA Main Agreement and Schedules MLPA performance indicators Dedicated Service Funding 24 2

25 Overview of the Agreement ( ) Content Ministry-LHIN JAC convened six meetings between January and April 2013 to discuss and endorse proposed content for the new Agreement ( ) (see Appendix A for MLPA timeline and Appendix B for JAC membership). The Agreement ( ) includes the following schedules, all receiving JAC endorsement (see Appendix C for more detailed description of schedules and Appendix E for list of indicators): o o o o o o o Main Agreement Schedule 1: General Schedule 2: Local Health System Program Specific Management Schedule 3: Long-Term Care Homes Schedule 4: Funding and Allocations* Schedule 5: Local Health System Performance** Schedule 6: Integrated Reporting * Financial tables available for inclusion in August ** Individual LHIN performance targets to be finalized in July

26 Key Changes in Approach for Agreement Key Changes in Approach: The Agreement needs to reflect Ontario s Action Plan for Health Care and include reference to key provincial strategies: Health Links, Seniors Strategy, Mental Health Strategy and Health System Funding Reform. o Example: Addition of the term other providers throughout the Agreement to reflect the need for LHINs to engage and work with the broader healthcare system, such as primary care physicians. Streamlined to be a higher-level document that does not duplicate details contained elsewhere, such as referencing a ministry-developed policy, guideline and/or provincial standard. o Example: Majority of capital provisions have been removed and replaced with reference to MOHLTC-LHIN Joint Review Framework for Early Capital Planning Stages and MOHLTC's Health Infrastructure Renewal Fund Guidelines (Schedule 1, s.18(a) and (c)). Implications: Any new or revised expectations would need to be communicated to the LHINs. o Example: A provision regarding French Language Services was removed and expectations regarding community engagement were clarified by revising the Annual Report Guidelines (shared with LHINs in April 2013). 4 26

27 Key Changes Provincial Priorities and Strategies: New provision to articulate LHIN role in Quality Improvement Plans (Schedule 1, s.2(b) and Schedule 2, s.9): The LHIN will work to align the Quality Improvement Plan (QIP) objectives and priorities of its health service providers to improve the quality of care across sectors and the healthcare system. The LHIN will require each Community Health Centre to submit a QIP to Health Quality Ontario that is aligned with and supports local health system priorities. New provision to articulate Ministry-LHIN role in service capacity planning (Schedule 1, s.3): Both parties will work together to develop a collaborative process to support current and future service capacity planning so that decisions about local service provision will advance provincial priorities and strategies. Implications: Signal expansion of Excellent Care for All Act beyond hospital sector to primary care and community care sectors, as well as the role of LHINs in their development. Commitment to comprehensive service capacity planning that involves both the ministry and the LHINs; this work supports the goal of longer-term vision for health system transformation and sustainable spending. 27 5

28 Key Changes Provincial Health Agencies: New provision to articulate Ministry-LHIN role in inter-agency collaboration (Schedule 1, s.4-5): The MOHLTC will work with the following provincial health agencies to ensure they equally consider the role of LHINs as local health system managers: Cancer Care Ontario; ehealth Ontario; Health Quality Ontario; and Ontario Agency for Health Protection and Promotion. The LHIN will work with the aforementioned provincial health agencies to support the fulfillment of provincial priorities and strategies. Implications: Existing accountability agreements and Memorandum of Understanding between the ministry and these agencies do not currently mention LHINs in their role as local health system managers; commitment by the ministry to help strengthen the relationship between LHINs and the aforementioned agencies. The LHINs will need to collaborate with these provincial agencies, particularly in their joint work with the ministry on service capacity planning. 28 6

29 Key Changes General Performance Obligations: New provision to ensure government priorities and strategies are reflected in LHIN accountability planning submission templates, service accountability agreements (SAAs) and schedules with health service providers (HSPs) and other providers (Schedule 1, s.22): Both parties will work together to ensure that government priorities and implementation of provincial strategies are reflected in accountability planning submission templates, service accountability agreements and schedules with health service providers and other providers. Implications: LHINs are now obligated to engage the ministry during the development of their accountability planning submissions and SAAs (Hospital, Community and Long-Term Care). Considered by both parties to be beneficial because it will ensure alignment of priorities at sector and system levels and reflection of accountabilities related to system goals. 29 7

30 Key Changes Dedicated Service Funding: A new approach has been developed based on the following principles: o o o Wherever possible, programs have been moved to program-specific schedules to clarify the role of both parties in determining and providing required service levels. If current service levels cannot be articulated, a program was included in the Dedicated Service Funding table (Schedule 4: Funding and Allocation), provided that there is confirmed oversight for the program by a ministry program area. If current service levels are not known and the funding is not monitored, the program was removed from the Dedicated Service Funding table (Schedule 4, Table 3 and 3a). Implications: For those programs that have been removed from the Dedicated Service Funding table in place of substantive provisions, the relevant ministry program areas are obligated to determine and advise the LHINs of service levels. The ministry will communicate reporting methods and requirements to the LHINs for programs that remain on the Dedicated Service Funding table (see Appendix E). 30 8

31 Key Changes Long-Term Care Homes: New provision to clarify that when a LTC health service provider s beds are closed or transferred to another LHIN or a licence expires, is surrendered or revoked, the residual funding for those beds reverts to the ministry. Removed the concept of dedicated funding for convalescent care beds and interim beds and clarified that the ministry sets the minimum number of these types of beds in the system and may flow additional dollars for these beds at its discretion. (All of LTC funding is essentially dedicated because it can only be used for licensed or approved LTC beds). Added some clarity to the drafting, for example: o o LHIN may apply ministry-approved reallocated funding from Beds in Abeyance to fund LHIN-requested temporary beds. Incorporated the rules pertaining to ministry direct funding and the prohibition on LHINs against funding LTC health service providers beyond what is permitted in the funding and financial management policies and the MLPA into the relevant provisions in the Schedule. 31 9

32 Key Changes Funding and Allocations: Reflection of HSFR in new definitions, provisions and funding tables (e.g. Schedule 4, s.3 (d) (e) and (f): The HBAM Funding set out in Tables 1a and 2a is subject to annual adjustment by the MOHLTC, and QBP funding set out in Tables 1a and 2a in this Schedule is subject to annual adjustment and is recoverable by the MOHLTC. The MOHLTC will reconcile all funding provided to the LHIN under this Agreement on an annual basis. The MOHLTC will recover funding from the LHIN if the MOHLTC has advised the LHIN that the particular funding is recoverable. New provision to strengthen accountability regarding financial documentation (Schedule 4, s.10 (b) and 11 (b): The Ministry may review the documentation identified in the Agreement during regular business hours and upon 24 hours notice to the LHIN. The LHIN will maintain documentation to support all financial statements and related payment instructions, including funding approval letters to health service providers and service accountability agreements signed between the LHIN and its health service providers

33 Key Changes Local Health System Performance: In January 2013, the ministry and LHINs jointly developed a Performance Framework that reflects direction articulated in Ontario s Action Plan for Health Care, as well as the principles in the Excellent Care for All Act (ECFAA), MLPA ( ) indicators are grouped into the following shared system goals: To enhance person-centred care To improve system integration and enhance coordination and transitions of care To implement evidence-based practice to drive quality, value and improved health outcomes Financial Sustainability See Appendix C for list of indicators and notes regarding revised methodology starting in 2013 (e.g., surgical and diagnostic imaging indicators have been revised from 90 th Percentile to Percent of Priority IV Cases Completed within Access Target ). Implications: In , the ministry will review new indicators associated with evolving provincial priorities and strategies (e.g., Health Links, Seniors Strategy) and engage LHIN representatives to participate, as required

34 Appendix A: Timeline for Development of MLPA ( ) Jan 2013 Feb 2013 Mar 2013 Apr 2013 May 2013 June 2013 July 2013 Aug - Oct 2013 Template Agreement Ministry-LHIN JAC developed and endorsed new template Agreement (April 2013) Financial Tables Ministry provide draft preliminary tables (May 2013) Ministry provide final preliminary tables (August2013) Performance Targets Ministry provide draft targets for each LHIN to consider (based on FY data posted May 13, 2013) (May 2013) Ministry and LHINs finalize performance targets (June July 2013) Approvals 34 Minister and LHIN Board Chair sign new MLPA ( ) (end of Aug/Sept 2013) English/French versions posted to Ministry and LHIN websites (Sept/Oct 2013) 12

35 Appendix B: Membership for JAC Ministry Co-Chair: Catherine Brown, ADM, Health System Accountability and Performance Division Helen Angus, Associate DM, Transformation Secretariat Susan Fitzpatrick, ADM, Negotiations and Accountability Management Division Don Young, ADM, Health System Information Management and Investment Division Kathryn McCulloch, Director, LHIN Liaison Branch (LLB) Director Participation (ad hoc as required) Support Paula Kashul, Legal Counsel, MOHLTC Legal Services Branch Leela Prasaud, Manager, LLB Christine Brown, Team Lead, LLB Julia Vaz-Jones, Program Consultant, LLB LHIN Co-Chair: Gary Switzer, CEO, Erie St Clair LHIN Bruce Lauckner, CEO, Waterloo Wellington LHIN Graeme Goebelle, Chair, Mississauga Halton LHIN John Langs, Chair, Central LHIN Robert Morton, Chair, North Simcoe Muskoka LHIN Support Eileen Clarke, Deputy Director, LHIN Legal Services Branch Janice Stephenson, Legal Counsel, LHIN Legal Services Branch 35 13

36 Appendix C: Content of MLPA ( ) Main Agreement Establishes the context for the agreement, as well as the joint responsibility of the ministry and LHINs to serve the public interest and effectively oversee the use of public funds; accountability of each party; and a proactive approach to performance improvement. Schedule 1: General Outlines the obligations of the ministry and LHINs for achieving government priorities and provincial strategies; consistent procedures and practices; system coordination and community engagement; information management; compliance; ehealth; capital and emergency management. Schedule 2: Local Health System Program Specific Management - Identifies the responsibilities of the ministry and LHINs in managing Provincial Programs, CHCs, Community Mental Health and Addictions. Schedule 3: Long-Term Care Homes - Identifies the responsibilities of the ministry and LHINs in managing long-term care homes (e.g., funding, beds in abeyance, short-stay program beds). Schedule 4: Funding and Allocation Outlines total funding to be allocated to the LHIN and sets out financial management requirements/policies for the use of financial resources. Schedule 5: Local Health System Performance Sets out the performance indicators and targets for the LHINs. Schedule 6: Integrated Reporting Summarizes of ministry and LHIN reporting obligations/timelines

37 Appendix D: MLPA ( ) Indicators Table A: To enhance person-centred care 1. 90th Percentile Emergency Room (ER) Length of Stay for Admitted Patients 2. 90th Percentile ER Length of Stay for Non-Admitted Complex (CTAS I-III) Patients 3. 90th Percentile ER Length of Stay for Non-Admitted Minor Uncomplicated (CTAS IV-V) Patients 4. Percent of Priority IV Cases Completed within Access Target for Cancer Surgery* 5. Percent of Priority IV Cases Completed within Access Target for Cardiac By-Pass Procedures* 6. Percent of Priority IV Cases Completed within Access Target for Cataract Surgery* 7. Percent of Priority IV Cases Completed within Access Target for Hip Replacement* 8. Percent of Priority IV Cases Completed within Access Target for Knee Replacement* 9. Percent of Priority IV Cases Completed within Access Target for Diagnostic MRI Scan* 10. Percent of Priority IV Cases Completed within Access Target for Diagnostic CT Scan* CTAS means Canadian Emergency Department Triage and Acuity Scale; and CMG means Case Mix Group. * The reporting for these indicators has been revised starting 2013/14; previous agreements included the 90 th percentile wait time for these surgical and diagnostic imaging services

38 Appendix D: MLPA Indicators Cont d Table B: To improve system integration and enhance coordination and transitions of care 11. Percentage of Alternate Level of Care (ALC) Days th Percentile Wait Time from Community for CCAC In-Home Services Application from Community Setting to First CCAC Service (excluding case management) 13. Wait Time from when CCAC Receives Application to LTCH when Assessment for Eligibility is Completed** ** New indicator for 2013/14; the ministry and LHINs will monitor performance in 2013/14 and work together to refine quality and consistency of data. Targets will be established starting 2014/15. Table C: To implement evidence-based practice to drive quality, value and improve health outcomes 14. Readmission within 30 Days for Selected CMGs 15. Repeat Unplanned Emergency Visits within 30 Days for Mental Health Conditions*** 16. Repeat Unplanned Emergency Visits within 30 Days for Substance Abuse Conditions*** *** The methodology for these indicators has been revised starting 2013/14; results may not be comparable to previous MLPA

39 Appendix E: Dedicated Service Funding for Dedicated Service Funding by Sector: Hospitals: Post Construction Operating Plan Community Health Centres: Uninsured Persons Services Mental Health: Consumer Survivor Initiatives Addictions: Problem Gambling Treatment Services Programs for Pregnant or Parenting Women with Problematic Substance Use Community Care Access Centres: School Health Professional and Personal Support Services Other: Compensation Under Specified Initiatives/Agreements 1 1 Includes CHC physician salaries and psychiatric sessional fees for community and hospital-based agencies

40 MINISTRY-LHIN PERFORMANCE AGREEMENT APRIL 1, 2013 MARCH 31, 2015 BETWEEN: Her Majesty the Queen in right of Ontario, as represented by the Minister of Health and Long-Term Care ( MOHLTC ) - and - XXXX Local Health Integration Network ( LHIN ) Introduction The Local Health System Integration Act, 2006 (LHSIA), the Memorandum of Understanding (MOU) and the Ministry-LHIN Performance Agreement ( Agreement ) are the key elements of the accountability framework between the MOHLTC and the Local Health Integration Networks (LHINs). The Agreement identifies the MOHLTC s key operational and funding expectations of the LHIN that are not already addressed in the LHSIA or the MOU. It recognizes that the MOHLTC and the LHIN have a joint responsibility to serve the public interest and effectively oversee the use of public funds. The Agreement reflects the LHINs critical role in ensuring enhanced access and quality of healthcare in a fiscally sustainable manner while acknowledging the MOHLTC s responsibility to apply appropriate and legitimate scrutiny of fiscal management and health services delivery by the LHINs. The MOHLTC has communicated provincial strategic direction that provides a vision for system change and reinforces the principles articulated in the Excellent Care for All Act, The MOHLTC and the LHINs used this vision to develop a Performance Framework focused on better patient outcomes and value for healthcare dollars. The framework includes the following shared system goals: Enhanced Person-Centred Care Improved System Integration and Enhance Coordination and Transitions of Care Implementation of Evidence-Based Practices to Drive Quality, Value and Improved Health Outcomes Financial Sustainability A number of key initiatives have been introduced to transform the healthcare system and achieve the vision set forth by the MOHLTC. The LHINs will work with health services providers and other providers to enhance collaboration within and between sectors and ensure alignment with current provincial strategies, including: Patient-Based Funding: a new funding strategy to facilitate fiscal sustainability and person-centred care. This will impact hospital, Community Care Access Centre (CCAC), and Long-Term Care Homes (LTCH) budgets. Health Links: an innovative approach to enhancing coordinated care for people who DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 1 of 39 May 15,

41 access the system frequently and at multiple entry points. Seniors Strategy: a provincial initiative to keep seniors healthy and at home longer and reduce pressures on hospitals and LTCHs by increasing capacity in the community. Mental Health and Addictions Strategy: an inter-ministerial commitment to improve the well-being of all Ontarians and create healthy, resilient communities. To further support the transformation agenda and address the demographic and fiscal challenges facing Ontario, comprehensive service capacity planning that includes both the MOHLTC and the LHINs is required. Primary Purpose of the Agreement 1. This Agreement outlines the mutual understanding between the MOHLTC and the LHIN of their respective performance obligations in the period from April 1, 2013 to March 31, 2015 covering the and fiscal years. This is an accountability Agreement for the purposes of s. 18 of the LHSIA. Principles 2. Both parties will carry out the responsibilities and obligations based on principles that reflect: a) Alignment with provincial priorities and strategies; b) Sustainability of the healthcare system by maximizing the efficient and effective use of public funds; c) Performance improvement; d) High-quality, person-centred service delivery; e) Consistency; f) Consultation and collaboration among MOHLTC, LHINs, health service providers, other providers and the applicable communities; g) Openness and transparency; and h) Innovation, creativity and flexibility. Definitions 3. The following terms have the following meanings in all the Schedules: Agreement means this Agreement, including any schedules, and any instrument which amends this Agreement. Annual Business Plan means the plan for spending the funding received by the LHIN from the MOHLTC and included in this Agreement as required by s. 18(2) (d) of the LHSIA. DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 2 of 39 May 15,

42 "Community" has the meaning set out in s. 16(2) of the LHSIA. Consolidation Report means a report that includes the LHIN s revenues and expenditures for LHIN operations and transfer payments to health service providers, and balance sheet accounts for the LHIN. Dedicated Service Funding means, in respect of a specific service, the funding that must be used by the LHIN to fund the provision of the specific service. ehealth means the coordinated and integrated use of electronic systems, information and communication technologies to facilitate the collection, exchange and management of personal health information in order to improve the quality, access, productivity and sustainability of the healthcare system. Key application areas of ehealth in Ontario include, but are not limited to: Electronic health information systems (e.g., electronic medical records, hospital information systems, electronic referral and scheduling systems, digital imaging and archiving systems, chronic disease management systems, laboratory information systems, drug information and eprescribing systems) Electronic health information access systems (e.g., provider portals, consumer ehealth) Underlying enabling systems (e.g., client/provider/user registries, health information access layer) Remote healthcare delivery systems (e.g., telemedicine services) ehealth Ontario means the government agency responsible to the Minister of Health and Long-Term Care which is a corporation without share capital created and continued in Ontario Regulation 43/02 made under the Development Corporations Act. Fiscal year means April 1 to March 31. "Health service provider" has the meaning set out in s. 2(1) of the LHSIA. Regular Report means a report that includes a statement of the LHIN s revenues, actual expenditures, forecasted expenditures for LHIN operations, transfer payments, an explanation of variances as required between the forecasted expenditures and revenues, and the identification of any financial and performance risks. Schedule means any one of and Schedules means any two or more of the schedules appended to this Agreement, including the following: 1. General; 2. Local Health System Program Management; 3. Long-Term Care Homes Program Specific Management 4. Funding and Allocations; 5. Local Health System Performance; and 6. Integrated Reporting. Service accountability agreement means the service accountability agreement that the LHIN and a health service provider are required to enter into under s. 20 (1) of the LHSIA. DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 3 of 39 May 15,

43 Year-end means the end of a fiscal year. Accountability 4. Both parties will fulfill their performance obligations in accordance with the terms of this Agreement. 5. Both parties will collaborate and cooperate to: a) Facilitate the achievement of the requirements of the Agreement; b) Promote financial sustainability and efficient utilization of financial resources; c) Develop clear and achievable service and financial performance obligations and identify risks to performance; d) Establish clear lines of communication and responsibility; and e) Work diligently to resolve issues in a proactive and timely manner. 6. The LHIN is responsible for managing its performance, the performance of the local health system, and collaborating with other providers to support provincial goals, as set out in the Agreement and using its authority under law. The MOHLTC is responsible for collaborating with the LHIN to achieve those ends. The MOHLTC and the LHIN recognize that issues may arise in the local health system that will require joint MOHLTC-LHIN problem-solving, decision making and action. Performance Improvement 7. Both parties will follow a proactive and responsive approach to performance improvement based on the following principles: a) Prudent financial management of public healthcare resources; b) Better access to high quality, person-centred services; c) Strengthened transitions in care across the entire patient journey; d) Ongoing performance improvement; e) An orientation to problem-solving; and f) A focus on relative risk of non-performance. 8. Where matters arise that could significantly affect either the LHIN or MOHLTC s ability to perform their obligations under this Agreement, they shall provide written notice to the other party as soon as reasonably possible (a Performance Factor ). Notice shall include a description of any remedial action the party has taken or plans to take to remedy the issue. Receipt of notice will be acknowledged within five business days of the date of the notice. 9. Both parties agree to meet and discuss the Performance Factor within one calendar month of the date of the notice. During the meeting, using the principles set out in paragraph 7, the parties will discuss: a) The causes of the Performance Factor; b) The impact of the Performance Factor and whether it poses a low, moderate or high risk to achieving the obligations of the Agreement; DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 4 of 39 May 15,

44 c) The steps in the performance improvement process to be taken to mitigate the impact of the Performance Factor; and d) Whether revisions or amendments to a party s performance obligations are required. 10. Where a LHIN Performance Factor is not mutually resolved, the Minister will determine the remedies to improve performance, depending on the extent, exposure or level of risk. Next MOHLTC LHIN Agreement 11. Both Parties will enter into a new agreement under s. 18 of the LHSIA to be effective at the end of this Agreement. If the new agreement is not signed by the Parties by April 1, 2015 this Agreement will continue in force until the new agreement is signed. Both Parties will make their best efforts to sign a new agreement as soon as they are able. General 12. Any amendment to this Agreement will only be effective if it is in writing and executed by the authorized representative of each party. 13. The LHIN will not assign any duty, right or interest under this Agreement without the written consent of the MOHLTC. 14. If a due date for materials falls on a weekend or on a holiday recognized by the MOHLTC, the materials are due on the next business day. 15. Each Schedule applies to the fiscal years, unless stated otherwise in a Schedule. Some of the performance obligations in a Schedule may apply only to one fiscal year, as stated in that Schedule. 16. Each party will communicate with each other about matters pertaining to this Agreement through the following persons: DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 5 of 39 May 15,

45 To the MOHLTC: Ministry of Health and Long-Term Care, Health System Accountability and Performance Division Hepburn Block, 5 th Floor 80 Grosvenor Street, Toronto, ON M7A 1R3 Attention: Assistant Deputy Minister, Health System Accountability and Performance Fax: (416) Telephone: (416) With a copy to: Director, Local Health Integration Network (LHIN) Liaison Branch 80 Grosvenor St. 5 th Floor, Hepburn Block Toronto, ON M7A 1R3 To the LHIN: Attention: Chair Fax: () - Telephone: () - With a copy to: Attention: CEO Fax: () - Telephone: () - Fax: (416) Telephone: (416) Made effective this 1 st day of April, 2013 by: Her Majesty the Queen in right of Ontario, as represented by the Minister of Health and Long- Term Care: The Honourable Deb Matthews Minister of Health and Long-Term Care XXXX Local Health Integration Network By: Name Chair DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 6 of 39 May 15,

46 Provincial Priorities and Strategies SCHEDULE 1: GENERAL 1. The MOHLTC will establish provincial priorities and strategies for the health system and communicate these priorities to the LHINs. 2. The LHIN will: a) Work with the MOHLTC, health service providers and other providers in the local health system to achieve and accelerate provincial priorities and strategies. b) Work to align the Quality Improvement Plan (QIP) objectives and priorities of its health service providers to improve the quality of care across sectors and the healthcare system. 3. Both parties will work together to develop a collaborative process to support current and future service capacity planning so that decisions about local service provision will advance provincial priorities and strategies. Provincial Health Agencies 4. The MOHLTC will work with the following provincial health agencies to ensure they equally consider the role of the LHINs as local health system managers: a) Cancer Care Ontario; b) ehealth Ontario; c) Health Quality Ontario; and d) Ontario Agency for Health Protection and Promotion. 5. The LHIN will work with the aforementioned provincial health agencies to support the fulfillment of provincial priorities and strategies. Consistency 6. The MOHLTC will identify common issues and services for which a consistent approach across LHINs is required. 7. The LHIN will work collaboratively with other LHINs, and in accordance with the MOU, to ensure a consistent approach for common issues and services, including those identified by the MOHLTC in subparagraph 6(a). Local System Coordination and Integration 8. The LHIN will work with its health service providers and other LHINs to improve governance, coordination and integration of healthcare delivery across the continuum of care and both within and between LHINs. Community Engagement 9. The LHIN will fulfill its community engagement requirements in accordance with the DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 7 of 39 May 15,

47 community engagement guidelines to ensure greater clarity and transparency of process. Information Management 10. The MOHLTC will: a) Develop, maintain and support health data standards, communicate health data reporting requirements and standards to the LHIN and health service providers, advise/inform health service providers of reporting and data quality issues, and, inform the LHINsand health service providers of reporting timelines; b) Consult with the LHIN to identify LHIN data/information requirements that support data infrastructure for LHIN operational needs, and prepare data sharing agreements and / or amendments to existing agreements as required; and c) Receive data and information from health service providers on behalf of the LHIN and provide timely access to the appropriate data to support health system needs. 11. The LHIN will: a) Require health service providers to submit data and information as communicated by the MOHLTC under subparagraph 8(a) to the MOHLTC, Canadian Institute for Health Information, or other third party; b) Identify LHIN data/information requirements to support the LHIN analysis at the local level, and work collaboratively with the MOHLTC to develop appropriate methodology, consistent data analysis and reporting; and c) Work with health service providers to improve data quality and timeliness as necessary. 12. Both parties will avoid duplicating data and information management infrastructure and processes, determine and prioritize data and information products, and streamline reporting requirements and timelines for the LHIN and health service providers. Compliance Protocols 13. The MOHLTC will: a) Retain its compliance, inspection and enforcement authorities under legislation; and b) Inform the LHIN as soon as reasonably possible on matters related to compliance, inspection and enforcement in LTCHs and otherwise through a mutually agreeable reporting schedule. 14. The LHIN will: a) Exercise its legislative and contractual authorities as necessary or as required under law, including conducting or requiring audits and reviews of health service providers; and DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 8 of 39 May 15,

48 ehealth b) Inform the MOHLTC as soon as reasonably possible: i) Of non-compliance by a health service provider with an assigned agreement, a service accountability agreement, or legislation, that has not been resolved to the LHIN s satisfaction; or ii) Of a health service provider that is licenced or approved to operate a LTCH, 15. The MOHLTC will: a) That is experiencing financial issues; b) Where the LHIN is aware that there is risk to resident health and/or safety in a LTCH; or c) Where the results of an audit or review conducted or required by a LHIN identifies problems. a) Set technical and information management standards related to ehealth and implementation / compliance timeframes for the interoperability of the health system in Ontario, including standards related to content, architecture, technology, privacy and security; and b) Review annual LHIN Cluster ehealth plans as submitted by the LHINs. 16. The LHIN will: a) Assist their respective LHIN Clusters to prepare an annual LHIN Cluster ehealth plan that aligns with the provincial ehealth priorities for , to be submitted to the MOHLTC for review; b) Include ehealth commitments in service accountability agreements requiring health service providers to: i) Assist the LHIN to implement provincial ehealth priorities for ; ii) Comply with any technical and information management standards, including those related to data, architecture, technology, privacy and security, set for health service providers by the MOHLTC or the LHIN within the timeframes set by the MOHLTC or the LHIN as the case may be; iii) Implement and use the approved provincial ehealth solutions identified in the LHIN Cluster ehealth plan; iv) Implement technology solutions that are compatible or interoperable with the provincial blueprint and with the LHIN Cluster ehealth plan; and DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 9 of 39 May 15,

49 v) Include, in their annual planning submissions, plans for achieving ehealth priority initiatives, including full adoption by all hospitals of Ontario Laboratory Information System by March Both parties will work together, and in conjunction with ehealth Ontario and Ontario Telemedicine Network as appropriate, to: Capital a) Participate in forums for the discussion of ehealth issues at a provincial level to identify options to support the roll out of ehealth initiatives and related ehealth issues including local health system needs, challenges, and opportunities and ehealth standards, definitions, and architectural frameworks; and b) Inform one another of significant issues or initiatives that contribute to or have an impact on provincial or local ehealth issues, strategies or work plans. 18. Both parties will: a) Follow the November 2010 MOHLTC-LHIN Joint Review Framework for Early Capital Planning Stages; b) Work together during the term of this Agreement to develop a revised or updated capital planning and delivery model for the early capital planning stages informed by service capacity planning by the MOHLTC, the LHINs and other provincial health agencies; c) Follow the MOHLTC's current Health Infrastructure Renewal Fund Guidelines; and d) Work together to devolve the review and approval process for Own-Funds Capital Projects from the MOHLTC to the LHIN, as appropriate. Emergency Management 19. Both parties will work together to implement the approved policy: The LHIN Role in Emergency Management (August 2012). General Performance Obligations 20. The MOHLTC will provide the LHIN with, and develop as appropriate, those provincial standards (such as operational, financial or service standards and policies, operating manuals and program eligibility), directives and guidelines that apply to health service providers, including providing the LHIN with relevant program manuals. 21. The LHIN will: a) Require health service providers to provide services funded by the LHIN in accordance with provincial standards, directives and guidelines provided pursuant to paragraph 20 above; DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 10 of 39 May 15,

50 b) Provide a certificates of compliance, or attestations as the case may be, to the MOHLTC in form and substance as required by the MOHLTC; c) Maintain the 10% reduction in executive office costs that it achieved between April 1, 2011 and March 31, 2013 against its 2010/11 budget; d) Require its hospitals and CCAC to maintain the 10% reduction that they achieved between April 1, 2011 and March 31, 2013 against their respective 2010/11 budgets; e) Not use, nor permit its hospitals and CCAC to use, funding provided under this Agreement to increase executive office budgeted costs during the term of this Agreement; and f) Report on their executive costs in an attestation to the MOHLTC, and require its hospitals and its CCAC to report on their respective executive office costs in an attestation to the MOHLTC. 22. Both parties will work together to ensure that government priorities and implementation of provincial strategies are reflected in accountability planning submission templates, service accountability agreements and schedules with health service providers and other providers. Annual Review and Update 23. Both Parties agree that the Schedules will be reviewed and updated annually, as necessary to better reflect the Primary Purpose, within 120 days of a budget announcement of the Government of Ontario. DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 11 of 39 May 15,

51 SCHEDULE 2: LOCAL HEALTH SYSTEM PROGRAM SPECIFIC MANAGEMENT Provincial Programs 1. The MOHLTC and the LHIN will establish a coordinated and effective system for the management of provincial programs. 2. The MOHLTC will: a) Identify provincial programs, determine any terms and conditions, including dedicated service funding, related to these provincial programs and communicate these to the LHIN; and b) Establish: (i) Roles and responsibilities related to provincial program delivery; and (ii) Performance management, monitoring and evaluation processes. 3. The LHIN will fulfill requirements as may be identified under paragraph 2 above and work with other LHINs to coordinate provincial program service delivery. Other MOHLTC Programs 4. If the MOHLTC establishes expectations and requirements for other programs, it will advise the LHIN. 5. The LHIN will require health service providers that provide the specific program to provide program services in accordance with the expectations and requirements established by the MOHLTC. Devolution 6. The MOHLTC: a) Will determine the devolution of province-wide programs to the LHINs; b) Will consult with LHINs before identifying a Lead LHIN; and c) May specify the terms and conditions applicable to the funding and administration of the province-wide program after its devolution. 7. The LHIN will: a) Administer the devolved program in accordance with the Agreement Concerning the Devolution of Provincial Programs, also known as the Lead LHIN Model Agreement and any terms and conditions specified by the MOHLTC; and DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 12 of 39 May 15,

52 b) Confirm any proposed changes to the Lead LHIN Model Agreement with the MOHLTC prior to implementation. Community Health Centres ( CHCs ) 8. The MOHLTC will support development of QIPs by providing the required templates, guidance and accompanying supports. 9. The LHIN will require each CHC to submit a QIP to Health Quality Ontario that is aligned with and supports local health system priorities. Mental Health 10. The MOHLTC will: a) Determine and advise the LHIN of the number of housing units that receive rent supplements for persons with serious mental illness and the specific agencies that receive the rent supplements for these units from the MOHLTC; b) Determine and advise the LHIN of the required service levels for supports to housing services for persons with serious mental illness who occupy the housing units that receive rent supplements as described in subparagraph 10(a); c) For forensic mental health services, determine and advise the LHIN of: (i) the number and type of forensic mental health inpatient beds and the forensic case management initiatives, and the Transitional Rehabilitation Housing Programs numbers and models; (ii) the designated hospitals that provide forensic mental health services; and (iii) the required service levels for forensic mental health services; and d) Determine and advise the LHIN of the type (adult or paediatric, inpatient, residential, day treatment or outpatient) and quantity of specialty eating disorder services, where applicable. 11. The LHIN will: a) Fund the provision by health service providers of a combination of community mental health services for the local health system, including services for people who have been in conflict with the criminal justice system; b) Fund the provision by health service providers of the following services: (i) Supports to housing services for persons who occupy the housing units that receive rent supplements at the service levels as described in subparagraph 10(b); (ii) forensic mental health services that include forensic mental health inpatient beds, forensic case management initiatives, and the Transitional Rehabilitation DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 13 of 39 May 15,

53 Addictions Housing Programs; and (iii) specialty eating disorder services; at the service levels as specified under paragraph 10; c) Require health service providers, designated as psychiatric facilities under the Mental Health Act, to provide the essential mental health services in accordance with the specific designation for that site and discuss any material changes to the service delivery models or service levels with the MOHLTC; and d) Not make any changes to the types and/or levels of service as specified under paragraph 10 without MOHLTC approval. 12. The MOHLTC will: a) Determine and advise the LHIN of type and quantity of problem gambling treatment and prevention services; b) Determine and advise the LHIN of the number of housing units that receive rent supplements for persons with problematic substance use and the specific agencies who receive the rent supplements for these units from the MOHLTC; and c) Determine and advise the LHIN of the required service levels for supports to housing services for persons with problematic substance use who occupy the housing units that receive rent supplements as described in paragraph 12(b). 13. The LHIN will: a) Fund the provision by health service providers of the following services: (i) Problem gambling treatment and prevention services as described in subparagraph 12(a); (ii) Supports to housing services for persons who occupy the housing units that receive rent supplements as described in subparagraph 12(c); and (iii) A combination of substance abuse treatment services for the local health system; and b) Not make any proposed changes to types and/or levels of service as specified under paragraph 12 without MOHLTC approval. DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 14 of 39 May 15,

54 SCHEDULE 3: LONG-TERM CARE HOMES PROGRAM SPECIFIC MANAGEMENT Definitions 1. Definitions below apply to Schedule 3: Long-Term Care Homes and Schedule 4: Funding and Allocations: Acknowledgement and Consent Agreement means an agreement entered into between the MOHLTC, the operator of a LTCH, and one or more lenders or secured parties, by which the MOHLTC consented to, or agreed to request a consent to, any of the following: (a) a mortgage of real property associated with the LTCH, (b) an assignment of a Development Agreement with the MOHLTC, and/or (c) an assignment of a service agreement; Beds in Abeyance means LTCH beds licensed or approved by the MOHLTC, for which the LTC health service provider has obtained written permission from the Director, PICB, in accordance with the LTCHA for the beds not to be available for occupancy.; Construction Funding Subsidy per diem or CFS per diem means any per diem funding paid pursuant to a Development Agreement; Convalescent Care Beds means those short-stay beds, licensed or approved under the LTCHA, that are part of a short-stay convalescent care program for which residents may be eligible for admission in accordance with regulations under the LTCHA; Development Agreement means an agreement between the MOHLTC and a LTC health service provider, or a proposed LTC health service provider, to develop, upgrade, retrofit or redevelop LTCH beds; Funding Policies means the funding and financial management policies determined by the MOHLTC for LTCHs as the same may be amended from time to time. Funding Policies establish the rates, and amounts and envelopes of all funding provided to LTC health service providers by the MOHLTC or the LHIN, including Supplementary Funding. Funding Policies also establish the applicable conditions for funding, the funding reconciliation rules, and the form, manner and content and date for submission of reports; Interim Beds means those short-stay beds that are licensed or approved under the LTCHA and that fall within the definition of interim bed in accordance with regulations under the LTCHA; LTCH means long-term care home; LTCH Protocol means the document titled Long-Term Care Homes Protocol as prepared and amended by the MOHLTC; LTCHA means the Long-Term Care Homes Act, 2007 and regulations thereunder; LTC health service provider means a health service provider that is a licensee within DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 15 of 39 May 15,

55 Funding the meaning of s. 2(1) of the LTCHA; Supplementary Funding means funding for LTCH beds provided directly by the MOHLTC to LTC health service providers in accordance with applicable Funding Policies and pursuant to a funding agreement between MOHLTC and the LTC health service provider; service agreement means the agreement pursuant to which funding is provided to a LTC health service provider and includes a service accountability agreement; service accountability agreement means the service accountability agreement between a LHIN and a LTC health service provider required by s. 20 of the LHSIA; and Short-Stay Respite Beds means those short-stay beds, licensed or approved under the LTCHA, that are part of a short-stay respite care program for which residents may be eligible for admission in accordance with regulations under the LTCHA. 2. The MOHLTC will: a) Determine and provide to the LHIN, the amount of funding that a LHIN may provide to a LTC health service provider together with any applicable terms and conditions; b) Determine any net projected unused funding for all LHINs that, as of September 30 in each fiscal year, has not or is projected not to be used by LTC health service providers; c) Reallocate a share of the net projected unused funding to the LHIN if the LHIN is projected to be overspent on its funding for the LTCH per diem rate; d) If there is net projected unused funding remaining after the reallocation, allocate to the LHIN by December 31 of each year a share of the unused funding in proportion to the number of LTCH beds that are licensed or approved and in operation in the LHIN s geographic area, other than (i) Beds in Abeyance and (ii) beds funded by the LHIN pursuant to paragraphs 18 and 21 of this Schedule, compared to the provincial total number of LTCH beds that are licensed or approved and in operation in the Province, other than Beds in Abeyance and beds funded by all the LHINs pursuant to paragraphs 18 and 21 of Schedule 3 to their respective Ministry LHIN Performance Agreements; and e) At its discretion, provide Supplementary Funding. 3. The LHIN will distribute and reconcile the funding provided under paragraph 2, pursuant to the terms of a service accountability agreement that is consistent with and requires adherence to the Funding Policies and any additional terms and conditions. For greater certainty, the LHIN may not provide any more funding to LTC health service providers than is identified in paragraph 2 above, except as provided in the Funding Policies and this Schedule. 4. If a LTC health service provider s beds are closed or transferred to another LHIN, or if a DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 16 of 39 May 15,

56 LTC health service provider s licence expires, is surrendered or is revoked under the LTCHA, the residual funding for the beds provided under subparagraph 2 (a) reverts to the MOHLTC. Construction Funding Subsidy (CFS) 5. The MOHLTC will: a) Determine the CFS per diem and the LTC health service providers in the geographic area of the LHIN that will receive the per diem, including any conditions on the funding and the number of beds for which the LTC health service provider will receive the CFS per diem; and b) Provide the CFS per diem to the LHIN. 6. The LHIN will provide the CFS per diem to LTC health service providers for each approved or licensed bed that is identified in paragraph 5 and operated in accordance with the MOHLTC s conditions of funding, applicable legislation or Development Agreement. 7. Every service accountability agreement entered into between the LHIN and the LTC health service provider during the term of this Agreement and in the future will contain an obligation on the LHIN to provide the CFS per diem to the LTC health service provider for the length of time set out in the particular Development Agreement for the particular beds. Assignment of LTC Service Agreement 8. Where the MOHLTC has entered into an Acknowledgement and Consent Agreement with a LTC health service provider and one or more lenders of the LTC health service provider (Lender) prior to the proclamation of the LTCHA, the LHIN will treat the MOHLTC s consent to assign the service agreement under the Acknowledgement and Consent Agreement as if MOHLTC had provided the consent on behalf of the LHIN. 9. Where an Acknowledgement and Consent Agreement or a Development Agreement between the MOHLTC and the LTC health service provider provides that the MOHLTC will request the LHIN to consent to an assignment of the service agreement, to the Lender or person designated by the Lender, the LHIN will consent to the assignment of the service agreement to that person where the MOHLTC so requests, and the consent shall be subject to terms and conditions similar to those of the Acknowledgement and Consent Agreement or the Development Agreement as the case may be. 10. In addition, the LHIN will not unreasonably withhold consent requested from a Lender, or from a receiver or receiver and manager appointed by a Lender or by a court order, to assign its or the LTC health service provider s right, title and interest in the service agreement or any part thereof or interest therein to another party, subject to all applicable legislative requirements. 11. Where the MOHLTC DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 17 of 39 May 15,

57 a) has entered into a Development Agreement with a LTCH health service provider or a proposed LTCH health service provider (an Operator ); b) has consented to the grant of a security interest to a Lender under the Development Agreement; and c) has directed the LHIN to consent to the assignment of the Operator s rights under a service accountability agreement, then the LHIN, d) Shall deliver to the Lender a commitment, in the MOHLTC s standard form, to provide the LHIN s consent to the assignment of the Operator s rights under the service accountability agreement between the Operator and the LHIN; e) Upon the grant of a licence to the Operator in respect of the Home, and for so long as a CFS is to be paid in respect of the Home, shall consent to the grant of a security interest in the service accountability agreement between the LHIN and the Operator in respect of the Home, provided that: 1) The security interest in the service accountability agreement may only be exercised together with the exercise of a security interest in the licence for the beds; and 2) The security interest is subject to all applicable statutory requirements and restrictions, including s. 107 of the LTCHA and s. 2(2), 19 and 20 of the LHSIA; and f) Shall amend s of the service accountability agreement in respect of the Home to remove the following sentence: No assignment or subcontract shall relieve the HSP from its obligations under this Agreement or impose any liability upon the LHIN to any assignee or subcontractor. Beds in Abeyance 12. The MOHLTC will review and may approve Beds in Abeyance applications in accordance with the Beds in Abeyance policy and LTCH Protocol. 13. In the event that an application is approved, the LHIN may seek and the MOHLTC may grant permission to temporarily use the amount of funding available as a result of any approved Beds in Abeyance applications. If the MOHLTC approves the LHIN s request, the LHIN may use the funding in accordance with the approval, including any conditions that may attach to the approval. Short-Stay Program Beds 14. The MOHLTC will: a) Determine the minimum threshold for occupancy for Short-Stay Respite Beds to inform approval of these beds in accordance with the LTCH Protocol; DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 18 of 39 May 15,

58 b) Determine the minimum number of Convalescent Care Beds and Interim Beds in the Province; c) In consultation with the LHIN, determine the LTC health service providers that will provide the Convalescent Care Beds and the Interim Beds and the number of those beds from the minimum number of beds determined in subparagraph (b); and d) Set other conditions for the operation of Convalescent Care Beds and Interim Beds. 15. The LHIN will: a) Take action as appropriate to improve the utilization of Short-Stay Respite Beds; b) Have the ability to set, in its discretion, a threshold for occupancy of Short-Stay Respite Beds that is higher than the minimum set by the MOHLTC pursuant to subparagraph14 (a); c) Determine which LTC health service providers will provide Short-Stay Respite Beds within the existing licensed or approved beds of each home and the number of such beds; d) Advise and/or make a proposal to MOHLTC about matters referred to in subparagraph 14(c); e) Incorporate the conditions referred to in subparagraph 14(d) in service accountability agreements; f) At its discretion, request that the MOHLTC approve the conversion of existing licensed or approved beds into Convalescent Care Beds additional to those identified in subparagraph14(b) in accordance with the LTCH Protocol; and g) Provide from its allocation, all additional funding for the converted Convalescent Care Beds approved by the MOHLTC pursuant to subparagraph 15(f) to LTC health service providers in accordance with the Funding Policies, including the additional subsidy for Convalescent Care Beds and the resident co-payment portion of the base level-of-care per diem funding. LHIN-Requested LTCH Beds 16. In paragraphs 17 and 18 LHIN Requested LTCH Beds means, subject to a determination under subparagraph 18(b), a LTCH bed funded by the LHIN out of its allocation, other than its allocation for LTCHs: a) That would increase the bed capacity of an existing LTCH licence issued under s.99, or an approval granted under s. 130 of the LTCHA; or b) In the case of a development or redevelopment, that is over and above the number of LTCH beds that the MOHLTC has approved a LTC health service provider for development or redevelopment. 17. The LHIN will: DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 19 of 39 May 15,

59 a) At its discretion, request LHIN Requested LTCH Beds; b) In its request identify (i) the number of LHIN Requested LTCH Beds requested; (ii) the estimated amount of funding required to support the beds in accordance with the Funding Policies, including Supplementary Funding and funding that would be paid in accordance with paragraphs 3 and 6 in this Schedule; and (iii) where, subject to a determination under subparagraph 18(b), the funding will be found within the LHIN s allocation, other than its allocation for LTCHs; and c) Fund the LHIN Requested LTCH Beds in accordance with the Funding Policies and paragraphs 3 and 5 of this Schedule if the LHIN s request for LHIN Requested LTCH Beds is granted by the MOHLTC. 18. The MOHLTC will: a) Consider the LHIN s request for LHIN Requested LTCH Beds and decide whether to grant the request. b) Determine the amount of funding, if any, that the MOHLTC may contribute; c) Confirm the amount of the funding required to support the beds in accordance with the Funding Policies, including Supplementary Funding and funding that would be calculated pursuant to paragraphs 2 and 5 in this Schedule; and d) Reallocate the confirmed funding from the sources identified by the LHIN to (i) the LHIN s allocation for LTCH beds for all funding to be paid in accordance with paragraphs 3 and 6 of this Schedule; and (ii) the MOHLTC s allocation for Supplementary Funding when the LHIN Requested LTCH Beds are available for occupancy. LHIN-Requested Temporary LTCH Beds 19. In paragraphs 20 and 21, LHIN Requested Temporary LTCH Beds means a LTCH bed for which the MOHLTC would issue a temporary licence in accordance with s. 111 of the LTCHA or increase the bed capacity of a temporary licence in accordance with the LTCHA, on the condition that the LTCH bed will be funded by the LHIN out of the LHIN s allocation, which may include funding approved for temporary use under paragraph The LHIN will: a) At its discretion, make a request for LHIN Requested Temporary LTCH Beds for a term of no longer than 5 years; b) In its request identify (i) the number of LHIN Requested Temporary LTCH Beds requested; (ii) the estimated amount of funding required to support the beds in accordance with the Funding Policies, including Supplementary Funding and funding that would be paid in accordance with paragraph 3; and (iii) where the funding will be found within the LHIN s allocation; and DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 20 of 39 May 15,

60 c) If the request is approved pursuant to paragraph 21, provide the funding identified in subparagraph 21(b) for the LHIN Requested Temporary LTCH Beds in accordance with the Funding Policies for the term of the temporary licence issued by the MOHLTC, including any increases in this funding and Supplementary Funding after the date the temporary licence is issued by the MOHLTC for these beds. 21. The MOHLTC will: a) Consider the LHIN s request for LHIN Requested Temporary LTCH Beds and decide whether to grant the request; b) Confirm the amount of funding required to support the beds in accordance with the Funding Policies, including Supplementary Funding and the funding paid in accordance with paragraph 3 of this Schedule. DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 21 of 39 May 15,

61 SCHEDULE 4: FUNDING and ALLOCATIONS Definitions 1. In this Schedule, the following terms have the following meanings: Funding Annual Balanced Budget means that, in a fiscal year, the total revenues are greater than or equal to the total expenses. Further, for the LHIN, the meaning of annual balanced budget is also subject to Public Sector Accounting Board (PSAB) rules as well as any interpretations issued by the MOHLTC in financial policies, directives or guidelines under paragraph 8. Health Based Allocation Model (HBAM) is a population health-based funding methodology that uses population and clinical information to inform funding allocation. HBAM Funding means the portion of funding allocated to a health service provider based on the results of HBAM allocation methodology. Multi-year funding targets means the funding targets for remaining years of the Agreement. Operating Budget means the budget for the LHIN s corporate operations. Quality Based Procedures (QBP) means the evidence-based funding determination that uses a price times volume methodology to calculate the funding for a targeted set of specific patient groups. QBP Funding means the amount allocated to a health service providers as a result of QBP analyses using QBP allocation methodology. Transfer Payment Budget means the budget for the LHIN s funding of health service providers. 2. The government s overall provincial LHIN funding allocations that have been updated from the Printed Estimates to include any additional funding to July 31, 2013 and any reallocations initiated by the LHINs are set out in the following tables, in this Schedule: a) Table 1 Statement of Overall LHIN Provincial Funding Allocation b) Table 1a Statement of Overall LHIN Provincial Funding Allocation Health System Funding Reform Budget c) Table 3 Statement of Overall LHIN Provincial Dedicated Service Funding by Sector 3. The MOHLTC: a) Will provide to the LHIN on August 20, 2013 the funding allocation, such funding allocation having been updated from the Printed Estimates to DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 22 of 39 May 15,

62 include any additional funding to July 31, 2013 and any reallocations initiated by the LHIN, set out in the following tables in this Schedule: (i) Table 2 Statement of Individual LHIN Funding Allocation (ii) Table 2a Statement of Individual LHIN Funding Allocation Health System Funding Reform Budget (iii) Table 3a Statement of Individual LHIN Dedicated Service Funding by Sector b) As the LHIN makes funding allocation decisions at the sector level throughout the year, will revise the Health Service Provider Transfer Payment Budget by Sector Initiatives allocation in Table 2 in this Schedule to the appropriate sectors; c) May set terms and conditions for any of the funding set out in the tables in this Schedule, including the type of funding (e.g. base or one-time), whether the funding is subject to annual adjustment, and whether and in what circumstances the funding may be recoverable from the LHIN by the MOHLTC: d) Has determined that HBAM Funding set out in Tables 1a and 2a is subject to annual adjustment by the MOHLTC, and QBP funding set out in Tables 1a and 2a in this Schedule is subject to annual adjustment and is recoverable by the MOHLTC; e) Will reconcile all funding provided to the LHIN under this Agreement on an annual basis; f) Will recover funding from the LHIN if the MOHLTC has advised the LHIN that the particular funding is recoverable; and g) May require the LHIN to carry out certain initiatives. 4. The LHIN: a) Will allocate the funds provided by the MOHLTC for , in accordance with the LHSIA, this Agreement and any applicable terms and conditions of which the LHIN is advised by the MOHLTC, including those set out in paragraph 3; b) Will carry out MOHLTC-required initiatives that may include: (i) Aboriginal Community Engagement, French Language Health Services, French Language Health Planning Entities, LHIN Shared Services Office, Diabetes Regional Coordination Centre Program, Emergency/Alternative Level of Care Performance Leeds, Emergency Department LHIN Leads and Critical Care LHIN Leads, as set out in Table 2 in this Schedule under LHIN Operating Budget Initiatives; and (ii) Aging At Home, Urgent Priorities Fund, ALC Investment, Behavioural Supports Ontario Project and funding for Community Investment Initiatives ($XXXM), as set out in Table 2 in this Schedule under Health Service Provider Transfer Payment Budget Initiatives. c) May, at its discretion, provide additional funding for the services for which Dedicated DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 23 of 39 May 15,

63 Service Funding is identified; and d) May, only with prior approval from the MOHLTC, reallocate unused Dedicated Service Funding to another service. If the MOHLTC does not give approval, the LHIN shall return unused Dedicated Service Funding to the MOHLTC. Long-Term Care Homes 5. The funding allocations in Tables 1 and 2 for LTCHs are only estimates that are subject to adjustment in accordance with the Funding Policies, including adjustments for reconciliation, Beds in Abeyance, and Construction Funding Subsidy per diem. Annual Balanced Budget Requirements 6. The LHIN will: a) Plan for an Annual Balanced Budget for its operations and health service provider transfer payments; b) Achieve an Annual Balanced Budget for its operations; and c) Require health service providers who receive LHIN funding through transfer payments to achieve an Annual Balanced Budget. Multi-Year Funding Requirements 7. The LHIN will plan and manage LHIN forecasted expenses for the LHIN s Operating and Transfer Payment Budgets within the multi-year funding targets set out in this schedule and the Multi-Year Funding Framework. Multi-year funding targets are to be used for planning purposes only and may be revised upward or downward at the discretion of the MOHLTC. Financial Management Polices and Guidelines 8. The MOHLTC may develop and issue to the LHIN policies, directives and guidelines related to financial management. 9. The LHIN will comply with all applicable legislation; including the Financial Administration Act, any MOHLTC policies, directives and guidelines issued to the LHIN related to financial management; as well as government financial management policies; guidelines; and directives, including the following: a) Multi-Year Funding Framework; b) Parameters for Financial Health Framework; c) Fiscal Prudence through Contingency Planning Policy; and d) Parameters for In Year and Year End Reallocations Policy. Accounting Standards 10. The MOHLTC: DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 24 of 39 May 15,

64 a) Will issue interpretations and modifications relating to Public Sector Accounting Board (PSAB) standards, based on advice from the Office of the Provincial Controller; and b) May review the documentation described in paragraph 11 during regular business hours and upon twenty-four hours notice to the LHIN. 11. The LHIN will: a) Prepare its financial reports and statements on its Operating and health service provider Transfer Payment Budgets, including its Annual Business Plan, based on the Public Sector Accounting Board (PSAB) standards, subject to modifications and interpretations issued as per paragraph 10. b) Maintain documentation to support all financial statements and related payment instructions, including funding approval letters to health service providers and service accountability agreements signed between the LHIN and its health service providers. DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 25 of 39 May 15,

65 Table 1: Statement of Overall LHIN Provincial Funding Allocation Funding Allocation (000's) Funding Allocation (000's) Total LHIN Operating Budget XXXX TBD Total Health Service Provider Transfer Payments XXXX TBD Operation of LHIN XXX TBD Initiatives XXX TBD E-Health XXX TBD Total Health Service Provider Transfer Payment Budget by Sector: Operations of Hospitals XXXX TBD Grants to Compensate for Municipal Taxation - Public Hospitals XXXX Long Term Care Homes XXXX TBD Community Care Access Centres XXXX TBD Community Support Services XXXX TBD Acquired Brain Injury XXXX TBD Assisted Living Services in Supportive Housing XXXX TBD Community Health Centres XXXX TBD Community Mental Health XXXX TBD Addictions Program XXXX TBD TBD Specialty Psychiatric Hospitals Grants to Compensate for Municipal Taxation - Psychiatric Hospitals XXXX XXXX TBD TBD Initiatives XXXX TBD DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 26 of 39 May 15,

66 Table 1a: Statement of Overall LHIN Provincial Funding Allocation - Health System Funding Reform Budget Funding Allocation (000s) (1) Funding Allocation (000s) (1) Total Health System Funding Reform Budget Total Health Service Provider Transfer Payments XXX TBD Total Health Service Provider Transfer Payments XXX TBD Hospitals Health Based Allocation Model (HBAM) Funding (2) XX TBD Quality Based Procedures (QBP) Funding (3) XX TBD Community Care Acces Centre Health Based Allocation Model (HBAM) Funding (2) XX TBD Quality Based Procedures (QBP) Funding (3) XX TBD 1. The amounts in this table are included in Table 1 under the respective sectors. 2. HBAM funding will be processed as base funding subject to annual adjustment. 3. QBP funding will be processed as base funding subject to annual adjustment and recovery. DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 27 of 39 May 15,

67 Table 2: Statement of Individual LHIN Funding Allocation Funding Allocation (000s) Funding Allocation (000s) Total LHIN Operating Budget XXXX TBD Total Health Service Provider (HSP) Transfer Payments XXXX TBD Operation of LHIN XXX TBD Initiatives XXX TBD E-Health XXX TBD Total Health Service Provider Transfer Payment Budget by Sector: XXXX Operations of Hospitals XXXX TBD Grants to compensate for Municipal Taxation - Public Hospitals XXXX Long Term Care Homes XXXX TBD Community Care Access Centres XXXX TBD Community Support Services XXXX TBD Acquired Brain Injury XXXX TBD Assisted Living Services in Supportive Housing XXXX TBD Community Health Centres XXXX TBD Community Mental Health XXXX TBD Addictions Program XXXX TBD Specialty Psychiatric Hospitals XXXX TBD Grants to compensate for Municipal Taxation - Psychiatric Hospitals XXXX Initiatives XXXX TBD TBD TBD TBD DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 28 of 39 May 15,

68 Table 2a: Statement of Individual LHIN Funding Allocation - Health System Funding Reform Budget Funding Allocation (000s) (1) Funding Allocation (000s) (1) Total Health System Funding Reform Budget Total Health Service Provider Transfer Payments XXX TBD Total Health Service Provider Transfer Payments XXX TBD Hospitals Health Based Allocation Model (HBAM) Funding (2) XX TBD Quality Based Procedures (QBP) Funding (3) XX TBD Community Care Acces Centre Health Based Allocation Model (HBAM) Funding (2) XX TBD Quality Based Procedures (QBP) Funding (3) XX TBD 1. The amounts in this table are included in Table 2 under the respective sectors. 2. HBAM funding will be processed as base funding subject to annual adjustment. 3. QBP funding will be processed as base funding subject to annual adjustment and recovery. DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 29 of 39 May 15,

69 Table 3: Statement of Overall LHIN Provincial Dedicated Service Funding by Sector Hospitals Dedicated Service Funding Allocation (000s) Post Construction Operating Plan XXX Community Health Centres Uninsured Persons Services XXX Mental Health Consumer Survivor Initiatives XXX Addictions Problem Gambling Treatment Services Programs for Pregnant or Parenting Women with Problematic Substance Use XXX XXX Community Care Access Centres School Health Professional and Personal Support Services XXX Other Compensation Under Specified Initiatives / Agreements (1) XXX 1. Includes CHC physician salaries and psychiatric sessional fees for community and hospital-based agencies. Table 3a: Statement of Individual LHIN Dedicated Service Funding by Sector Hospitals Dedicated Service Funding Allocation (000s) Post Construction Operating Plan XXX Community Health Centres Uninsured Persons Services XXX Mental Health Consumer Survivor Initiatives XXX Addictions Problem Gambling Treatment Services Programs for Pregnant or Parenting Women with Problematic Substance Use XXX XXX Community Care Access Centres School Health Professional and Personal Support Services XXX Other Compensation Under Specified Initiatives / Agreements (1) XXX 1. Includes CHC physician salaries and psychiatric sessional fees for community and hospital-based agencies. DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 30 of 39 May 15,

70 Definitions SCHEDULE 5: LOCAL HEALTH SYSTEM PERFORMANCE 1. In this Schedule, the following terms have the following meanings: LHIN baseline means the result at a given time for a performance indicator that provides a starting point for measuring changes in local health system performance and for establishing LHIN targets for future local health system performance; LHIN target means a planned result for an indicator against which actual results can be compared; Performance indicator means a measure of local health system performance for which a LHIN target will be set, and the LHIN will be held accountable for achieving results under the terms of this Agreement for the local health system in connection with a performance indicator; Provincial target means an optimal performance result for an indicator, which may be based on expert consensus, performance achieved in other jurisdictions, or provincial expectations; CTAS means Canadian Emergency Department Triage and Acuity Scale; and CMG means Case Mix Group. General Obligations 2. Under the Act and the Commitment to the Future of Medicare Act, the LHIN will measure and plan to improve performance at the local level through service accountability agreements with health service providers. Specific Obligations 3. The MOHLTC will: a) Calculate the results for the performance indicators set out in Tables 1, 2 and 3: b) Provide the LHIN with calculated results for the performance indicators by the release dates set out in Schedule 6, and supporting performance information as requested, such as the performance of health service providers; and c) Provide the LHIN with technical documentation for the performance indicators set out in Tables 1, 2 and 3, including the methodology, inclusions and exclusions. 4. The LHIN will: a) Work to achieve the LHIN s performance targets for the performance indicators; b) Report quarterly on the performance of the local health system on all performance indicators; and DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 31 of 39 May 15,

71 c) Report on the performance of the local health system on all performance indicators in the LHIN Annual Report. Objective: To enhance person-centred care Table 1: Performance Indicators Expected Outcome: Persons will experience improved access to healthcare services identified below in alignment with best practices. INDICATOR Provincial target LHIN Baseline LHIN Target th Percentile Emergency Room (ER) Length 8 hours of Stay for Admitted Patients 90th Percentile ER Length of Stay for Non- 8 hours Admitted Complex (CTAS I-III) Patients 90th Percentile ER Length of Stay for Non- 4 hours Admitted Minor Uncomplicated (CTAS IV-V) Patients Percent of Priority IV Cases Completed Priority IV: 84 days Within Access Target for Cancer Surgery * Percent of Priority IV Cases Completed Priority IV: 90 days Within Access Target for Cardiac By-Pass Procedures * Percent of Priority IV Cased Completed Priority IV: 182 Within Access Target for Cataract Surgery * days Percent of Priority IV Cases Completed Priority IV: 182 Within Access Targets for Hip Replacement * days Percent of Priority IV Cases Completed Priority IV : 182 Within Access Target for Knee Replacement * days Percent of Priority IV Cases Completed Priority IV : 28 days Within Access Target for MRI Scan * Percent of Priority IV Cases Completed Priority IV : 28 days Within Access Target for Diagnostic CT Scan* * The reporting for these indicators has been revised starting 2013/14. Previous Agreements included the 90 th percentile wait time for these surgical and diagnostic imaging services DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 32 of 39 May 15,

72 Table 2: Performance Indicators Objective: To improve system integration and enhance coordination of care while ensuring better transitions to various care settings. Expected Outcome: Persons will be able to navigate the healthcare system and receive the care they need, when and where they need it. INDICATOR Provincial target LHIN Baseline LHIN Target Percentage of Alternate Level of Care (ALC) 9.46% Days 90th Percentile Wait Time from Community To be determined for CCAC In-Home Services Application (TBD) from Community Setting to first CCAC Service (excluding case management) Wait Time from When CCAC Receives (TBD) Application to Long Term Care Home to When Assessment for Eligibility is Completed * * New indicator for 2013/14. The MOHLTC and the LHINs will monitor performance in 2013/14 and work together to refine quality and consistency of data. Targets will be established starting 2014/15. Table 3: Performance Indicators Objective: To implement evidence based practice to drive quality and value and improve health outcomes Expected Outcome: Persons will receive quality inpatient care and coordinated post-discharge care, leading to reduced readmission rates that may improve survival, quality of life and other outcomes without increasing cost. INDICATOR Provincial target LHIN Baseline Readmissions within 30 days for Selected TBD CMGs Repeat Unscheduled Emergency Visits within TBD 30 days for Mental Health Conditions ** Repeat Unscheduled Emergency Visits within TBD 30 days for Substance Abuse Conditions ** ** The methodology for these indicators has been revised starting 2013/14. Results may not be comparable to the previous Agreement. LHIN Target DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 33 of 39 May 15,

73 General Obligations 1. The MOHLTC will: SCHEDULE 6: INTEGRATED REPORTING a) Provide any necessary training, instructions, materials, data, templates, forms, and guidelines to the LHIN to assist with the completion of the reports listed in Table 1; and b) As required, develop reporting requirements relating to government priorities and notify the LHIN of the requirements; 2. Both parties will: a) Work together to ensure a timely flow of information, including financial records, to fulfill the reporting requirements of both parties; b) Finalize the Annual Business Plan within 120 days of a budget announcement by the Government of Ontario as part of the annual review set out in Schedule 1: General. DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 34 of 39 May 15,

74 Table 1: MOHLTC and LHIN Reporting Obligations (2013/14) Due Date April 16, 2013 April 30, 2013 April 30, 2013 April 30, 2013 May 13, 2013 May 14, 2013 May 17, 2013 May 31, 2013 June 3, 2013 On or about the 7 th working day (date may depending on the IFIS GL close) June 28, 2013 June 28, 2013 June 28, 2013 July 31,2013 July 31,2013 August 12, 2013 August 15, 2013 Description of Item 2013/2014 APRIL MOHLTC will provide to the LHIN a Year End Report confirming the expenditures and revenue related to its transfer payments as of March 31 of the preceding fiscal year MOHLTC will provide to the LHIN the forms for the Year-end Consolidation Report The LHIN will submit to the MOHLTC a Quarterly Expense Report using the forms provided by the MOHLTC The LHIN will submit to the MOHLTC an Attestation as required under the Broader Public Sector Accountability Act (BPSAA) MAY MOHLTC will provide the LHIN with the most recent quarter of data for indicators in Schedule 5: Local Health System Performance MOHLTC will provide to the LHIN a Year End Report with updated expenditures and revenue related to its transfer payments as of March 31 of the preceding fiscal year The MOHLTC will provide to the LHIN for planning and reporting purposes the initial preliminary allocation for The LHIN will submit to the MOHLTC the year-end consolidation report using forms provided by the MOHLTC and the draft Audited Financial Statement if the signed statements are not ready by May 31 of each fiscal year to which this agreement applies JUNE The LHIN will submit to the MOHLTC a report on performance indicators using the forms provided by the MOHLTC MOHLTC will make the expenditure and revenue report available to the LHIN in APTS for the LHIN s review The LHIN will submit to the MOHLTC Q1 Regular and Consolidation Report using the forms provided by the MOHLTC The LHIN will submit to the MOHLTC an Annual Report for the previous fiscal year in accordance with MOHLTC requirements The LHIN will submit to the MOHLTC a Board approved report on consultant use for the previous fiscal year using the template provided in the Minister s Directive under the BPSAA JULY The LHINs will submit to the MOHLTC a Quarterly Expense Report using the forms provided by the MOHLTC The LHIN will submit to the MOHLTC an Attestation as required under the BPSAA AUGUST The MOHLTC will provide to the LHIN the most recent quarter of performance data for indicators in Schedule 5: Local Health System Management The MOHLTC will provide the preliminary approved allocation for the current fiscal year, as of July 31, 2013 DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 35 of 39 May 15,

75 Due Date August 30, 2013 September 3, 2013 On or about the 7 th working day (date may vary on IFIS GL close) September 30, 2013 September 30, 2013 October 31, 2013 (or date necessary to meet central agency reporting requirements) By October 31, 2013 October 31, 2013 November 12, 2013 December 2, 2013 On or about the 7 th working day (date may vary depending on the IFIS GL close) December 31, 2013 January 31, 2014 By January 31, 2014 January 31, 2014 February 10, 2014 February 14, 2014 March 3, 2014 Description of Item MOHLTC will provide to the LHIN the forms and information requirements for the Multi-year Consolidation Report SEPTEMBER The LHIN will submit to the MOHLTC a report on performance indicators using the forms provided by the MOHLTC The MOHLTC will make the expenditure and revenue report available to the LHIN in APTS for the LHIN s review The LHIN will submit to the MOHLTC Q2 Regular and Consolidation Report using the forms provided by the MOHLTC The MOHLTC will provide to the LHIN the forms and information requirements for the 2014/15 Annual Business Plan OCTOBER The LHIN will submit to the MOHLTC a Multi-year Consolidation Report using the form provided by the MOHLTC The LHIN will submit to the MOHLTC an Attestation as required under the BPSAA The LHINs will submit to the MOHLTC a Quarterly Expense Report using the forms provided by the MOHLTC NOVEMBER MOHLTC will provide to the LHIN the most recent quarter of performance data for indicators in Schedule 5: Local Health System Management DECEMBER The LHIN will submit to the MOHLTC a report on performance indicators using the forms provided by the MOHLTC The MOHLTC will make the expenditure and revenue report available to the LHIN in APTS for the LHIN s review LHIN will submit to the MOHLTC Q3 Regular and Consolidation Report including final year-end forecast using the forms provided by the MOHLTC JANUARY MOHLTC will provide the LHIN with year-end instructions (including templates) The LHIN will submit to the MOHLTC an Attestation required under the BPSAA The LHINs will submit to the MOHLTC a Quarterly Expense Report using the forms provided by the MOHLTC FEBRUARY MOHLTC will provide the LHIN with most recent quarter of performance data for indicators in Schedule 5: Local Health System Performance MOHLTC will provide to the LHIN the forms and requirements for the Annual Report (non-financial content) MARCH The LHIN will submit to the MOHLTC a report on performance indicators using the forms provided by the MOHLTC DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 36 of 39 May 15,

76 Due Date March 28, 2014 March 31, 2014 April 15, 2014 April 15, 2014 April 30, 2014 By April 30, 2014 April 30, 2014 May 12, 2014 May 13, 2014 May 16, 2014 May 30, 2014 June 2, 2014 On or about the 7 th working day (date may vary depending on the IFIS GL close) June 30, 2014 June 30, 2014 June 30, 2014 July 31,2014 July 31,2014 Description of Item MOHLTC will provide to the LHIN the forms for the Annual Report (financial content) The LHIN will submit to the MOHLTC a Draft 2014/15 Annual Business Plan using the forms provided by the MOHLTC 2014/2015 APRIL MOHLTC will provide to the LHIN a Year End Report confirming the expenditures and revenue related to its transfer payments as of March 31 of the preceding fiscal year The LHIN will submit to the MOHLTC Year End Reallocation Report on actual expenditures related to in-year reallocations as of March 31 of the preceding fiscal year MOHLTC will provide to the LHIN the forms for the Year-end Consolidation Report The LHIN will submit to the MOHLTC an Attestation as required under the BPSAA The LHINs will submit to the MOHLTC a Expense Report using the forms provided by the MOHLTC MAY The MOHLTC will provide to the LHIN the most recent quarter of performance data for indicators in Schedule 5: Local Health System Performance MOHLTC will provide to the LHIN a Year End Report with updated expenditures and revenue related to its transfer payments as of March 31, of the preceding fiscal year The MOHLTC will provide to the LHIN for planning and reporting purposes the initial preliminary allocation for The LHIN will submit to the MOHLTC the year-end consolidation report using forms provided by the MOHLTC and the draft Audited Financial Statement if the signed statements are not ready by May 31 of each fiscal year to which this agreement applies JUNE The LHIN will submit to the MOHLTC a report on performance indicators using the forms provided by the MOHLTC The MOHLTC will make the expenditure and revenue report available to the LHIN is APTS for the LHIN s review The LHIN will submit to the MOHLTC Q1 Regular and Consolidation Report using the forms provided by the MOHLTC The LHIN will submit to the MOHLTC an Annual Report for the previous fiscal year in accordance with MOHLTC requirements The LHIN will submit to the MOHLTC a Board approved report on consultant use for the previous fiscal year using the template provided in the Minister s Directive under the BPSAA JULY The LHINs will submit to the MOHLTC a Quarterly Expense Report using the forms provided by the MOHLTC The LHIN will submit to the MOHLTC an Attestation as required under the BPSAA DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 37 of 39 May 15,

77 Due Date August 12, 2014 August 15, 2014 August 29, 2014 September 2, 2014 On or about the 7 th working day (date may vary on IFIS GL close) September 30, 2014 September 30, 2014 October 31, 2014 (or date necessary to meet central agency reporting requirements) By October 31, 2014 October 31, 2014 November 12, 2014 December 2, 2014 On or about the 7 th working day (date may vary depending on the IFIS GL close) December 31, 2014 January 30, 2015 By January 30, 2015 January 30, 2015 February 10, 2015 Description of Item AUGUST The MOHLTC will provide to the LHIN the most recent quarter of performance data for indicators in Schedule 5: Local Health System Management The MOHLTC will provide the preliminary approved allocation for the current fiscal year, as of July 31, 2014 MOHLTC will provide to the LHIN the forms and information requirements for the Multi-year Consolidation Report SEPTEMBER The LHIN will submit to the MOHLTC a report on performance indicators using the forms provided by the MOHLTC The MOHLTC will make the expenditure and revenue report available to the LHIN in APTS for the LHIN s review The LHIN will submit to the MOHLTC Q2 Regular and Consolidation Report using the forms provided by the MOHLTC The MOHLTC will provide to the LHIN the forms and information requirements for the 2014/15 Annual Business Plan OCTOBER The LHIN will submit to the MOHLTC a Multi-year Consolidation Report using the form provided by the MOHLTC The LHIN will submit to the MOHLTC an Attestation as required under the BPSAA The LHINs will submit to the MOHLTC a Quarterly Expense Report using the forms provided by the MOHLTC NOVEMBER MOHLTC will provide to the LHIN the most recent quarter of performance data for indicators in Schedule 5: Local Health System Management DECEMBER The LHIN will submit to the MOHLTC a report on performance indicators using the forms provided by the MOHLTC The MOHLTC will make the expenditure and revenue report available to the LHIN in APTS for the LHIN s review LHIN will submit to the MOHLTC Q3 Regular and Consolidation Report including final year-end forecast using the forms provided by the MOHLTC JANUARY MOHLTC will provide the LHIN with year-end instructions (including templates) The LHIN will submit to the MOHLTC an Attestation required under the BPSAA The LHINs will submit to the MOHLTC a Quarterly Expense Report using the forms provided by the MOHLTC FEBRUARY MOHLTC will provide the LHIN with most recent quarter of performance data for indicators in Schedule 5: Local Health System Performance DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 38 of 39 May 15,

78 Due Date February 13, 2015 March 3, 2015 March 27, 2015 March 31, 2015 Description of Item MOHLTC will provide to the LHIN the forms and requirements for the Annual Report (non-financial content) MARCH The LHIN will submit to the MOHLTC a report on performance indicators using the forms provided by the MOHLTC MOHLTC will provide to the LHIN the forms for the Annual Report (financial content) The LHIN will submit to the MOHLTC a Draft 2015/16 Annual Business Plan using the forms provided by the MOHLTC DRAFT Ministry-LHIN Performance Agreement (2013/ /15) Page 39 of 39 May 15,

79 Note A motion to support the MLPA will be circulated to Board members in September. 79

80 North East LHIN Briefing Note NE LHIN CEO NE LHIN Board of Directors Audience Other: Author(s) Marc Demers Officer, Performance and Decision Support Date 2013/08/14 Subject Hospital Working Funds Initiative and Quarterly Reporting Recommended Action For Decision For Information Other (specify) Background and Context Purpose of Funding: One-time funding to be used solely to improve the Adjusted Working Funds deficit position of the Hospital to up to a maximum of 4% of Total Revenues in a manner that is fiscally neutral to the province. The hospital has additional reporting requirements under this initiative, the reporting timelines are as follows: submission Date Hospital to LHIN: 45 days after quarter end; Submission Date LHIN to Ministry: 75 days after quarter end. Signatures: Before being submitted to the ministry, the report must include signatures from the following: Hospital CEO, Hospital Board Chair, LHIN CEO, and LHIN Board Chair. Shortfall Plan: If the hospital is forecasting a shortfall in reaching their Hospital Working Funds Accountability Agreement performance targets, an explanation and plan to correct any shortfall in their performance must be included. LHIN Review: LHINs review the hospital submitted reports to ensure completeness and accuracy of responses before submission to the ministry. Uses of Funds: as per Hospital Working Funds Accountability Agreement: to permanently reduce or eliminate the need for a cash advance and reduce the temporary borrowing the hospital incurs at year end; to pay down current bank indebtedness; or with prior approval from the LHIN or ministry, to pay for an existing Current Liability. Cash advances: cash advances must be reduced by at least the amount of the Adjusted Working Funds improvement. Monitoring: by the LHIN for improvement on the following additional indicators: Current Ratio, Adjusted Current Ratio, Debt Ratio. Financial Information Sault Area Hospital and Timmins District Hospital are presently part of this initiative. Next Steps / Recommendations Continue to monitor hospitals receiving working funds relief to ensure they meet contractual obligations. Continue to support NBRHC & HSN in attaining working funds relief to help them address their working funds deficit. Key Messages The Hospital Working Funds Initiative acts as an incentive for hospitals to balance budgets and reduce their own working fund deficits as well as provides them with one-time funding support (multiyear). The NE LHIN will continue to monitor hospitals progress to ensure they meet the Hospital Working Funds Accountability Agreement. There are no risks identified. Reviewed/Approved By File Path: (SharePoint) Kathleen Fyfe, SD System Performance North East Local Health Integration Network Briefing Note 148

81 HOSPITAL WORKING FUNDS INITIATIVE QUARTERLY REPORT HOSPITAL NAME Sault Area Hospital 0965 For fiscal year: 2012/ /14 X 2014/15 For the Quarter ending: June X Sept December March Submission Date Hospital to LHIN: 45 days after quarter end (Q1 - August 14, Q2 - November 14, Q3 - February 14, Q4 - May 15) Submission Date LHIN to Ministry: 75 days after quarter end (Q1 - September 13, Q2 - December 14, Q3 - March 16, Q4 - June 14) Financial Report 1. Annual Balanced Budget (HSAA definition) (actuals per audited financial statements) restated Actual Actual Forecast 2011/ / /14 Revenues 202,919, ,779, ,178,835 Expenses 187,001, ,158, ,856,735 HSAA definition Surplus/(Deficit) 15,917,412 17,621,316 16,322,100 Using the HSAA definition, is the hospital forecasting a balanced Budget for 2013/14? Yes X No Does this forecast include the 2013/14 Working Funds remedy funding? Yes X No 2. Adjusted Working Funds Deficit (actuals per audited financial statements and MIS) Actual Actual Forecast 2011/ / / Current Assets 17,939,583 29,720,225 18,664, Unrestricted or internally restricted long-term investments Portion of externally restricted long-term investments that is NOT restricted (eg. Interest) Externally restricted cash and cash equivalents reported in current assets Externally restricted investments reported in current assets Externally restricted receivables reported in current assets Trust or research funds not included in current assets that are available to operations Other non-current assets not externally restricted available for working funds Other adjustments to working funds not previously reported above 2.10 Adjusted Current Assets 17,939,583 29,720,225 18,664, Current Liabilities 73,511,126 55,380,613 36,596, Total vacation accrual (6,845,251) (6,884,680) (6,800,000) Cash payouts for terminations and retirements 410, , ,000 (6% assumption - calculated) Vested sick leave accruals in current liabilities (177,694) (152,398) (100,000) Average annual payout from vested sick bank 29,460 25,296 52, Callable debt and short-term debt that is deemed to be long-term in nature Current portion of long-term debt not already in current liabilities Any current liability associated with 2.4, 2.5, & Other adjustments to working funds not previously reported above 2.20 Adjusted Current Liabilities 66,928,356 48,781,912 30,157, Adjusted Working Funds Deficit (A) (48,988,773) (19,061,687) (11,492,529) Amount Per Hospital Working Funds Accountability Framework Agreement (21,132,261) SHORTFALL (if any) 0 149

82 HOSPITAL WORKING FUNDS INITIATIVE QUARTERLY REPORT HOSPITAL NAME Sault Area Hospital 0965 For fiscal year: 2012/ /14 X 2014/15 For the Quarter ending: June X Sept December March Submission Date Hospital to LHIN: 45 days after quarter end (Q1 - August 14, Q2 - November 14, Q3 - February 14, Q4 - May 15) Submission Date LHIN to Ministry: 75 days after quarter end (Q1 - September 13, Q2 - December 14, Q3 - March 16, Q4 - June 14) Financial Report Plan to Correct Shortfall by March 31, Adjusted Working Funds Deficit/Total Revenue % (actuals per audited financial statements) Actual Actual Forecast 2011/ / /14 Total Revenues 225,185, ,465, ,148,484 Adjusted Working Funds Deficit from Above (A) (48,988,773) (19,061,687) (11,492,529) Adjusted Working Funds Deficit/Total Revenue % % -8.38% -5.22% Percentage Per Hospital Working Funds Accountability Framework Agreement % SHORTFALL (if any) 0.0% Plan to Correct Shortfall by March 31, Cash Advance Actual Actual Forecast 2011/ / /14 Cash Advance Amount (Before Year End Bridging) 37,000,000 19,178,000 4,355,900 Note: The 2013/14 Year 3 funding remedy should be excluded from the 2013/14 forecast of the cash advance. Cash Advance Per Hospital Working Funds Accountability Framework Agreement - SHORTFALL (if any) (4,355,900) 5. Current Ratio (Current Assets/Current Liabilities) (automatically calculated from data above) restated Actual Actual Forecast 2011/ / /14 Current Assets 17,939,583 29,720,225 18,664,477 Current Liabilities 73,511,126 55,380,613 36,596,608 Current Ratio Is Current Ratio Improving? Yes No X 150

83 HOSPITAL WORKING FUNDS INITIATIVE QUARTERLY REPORT HOSPITAL NAME Sault Area Hospital 0965 For fiscal year: 2012/ /14 X 2014/15 For the Quarter ending: June X Sept December March Submission Date Hospital to LHIN: 45 days after quarter end (Q1 - August 14, Q2 - November 14, Q3 - February 14, Q4 - May 15) Submission Date LHIN to Ministry: 75 days after quarter end (Q1 - September 13, Q2 - December 14, Q3 - March 16, Q4 - June 14) Financial Report 6. Adjusted Working Funds Current Ratio (automatically calculated from data above) Actual Actual Forecast 2011/ / /14 Adjusted Current Assets 17,939,583 29,720,225 18,664,477 Adjusted Current Liabilities 66,928,356 48,781,912 30,157,006 Adjusted Current Ratio Is Adjusted Current Ratio Improving? Yes X No If NO then provide plan to correct 7. Debt Ratio (Total Liabilities/Total Assets) (actuals per audited financial statements) restated Actual Actual Forecast 2011/ / /14 Total Assets 376,736, ,951, ,664,477 Total Liabilities 435,183, ,381, ,102,766 Debt Ratio Is Debt Ratio Improving? Yes X No If NO then provide plan to correct /14 Working Funds Remedy Uses Please provide a brief description of the proposed uses for the 2013/14 Working Funds Remedy funding. Remedy funding will be used to reduce the hospital's operating line. 151

84 HOSPITAL WORKING FUNDS INITIATIVE QUARTERLY REPORT HOSPITAL NAME Sault Area Hospital 0965 For fiscal year: 2012/ /14 X 2014/15 For the Quarter ending: June X Sept December March Submission Date Hospital to LHIN: 45 days after quarter end (Q1 - August 14, Q2 - November 14, Q3 - February 14, Q4 - May 15) Submission Date LHIN to Ministry: 75 days after quarter end (Q1 - September 13, Q2 - December 14, Q3 - March 16, Q4 - June 14) Financial Report Approvals and Contact 9. Hospital Contact Info Contact's name: Max S. Liedke Contact's position: VP & CFO Contact's telephone number: Contact's liedkem@sah.on.ca Contact's fax number: Date (dd-mm-yy) 8/15/2013 Please provide any additional comments below: 152

85 HOSPITAL WORKING FUNDS INITIATIVE QUARTERLY REPORT HOSPITAL NAME Sault Area Hospital 0965 For fiscal year: 2012/ /14 X 2014/15 For the Quarter ending: June X Sept December March Submission Date Hospital to LHIN: 45 days after quarter end (Q1 - August 14, Q2 - November 14, Q3 - February 14, Q4 - May 15) Submission Date LHIN to Ministry: 75 days after quarter end (Q1 - September 13, Q2 - December 14, Q3 - March 16, Q4 - June 14) Financial Report 10. Approvals and Attestation - Funding Restrictions Hospital CEO and Board Chair have reviewed and hereby approve the above quarterly report. Hospital CEO and Board Chair attest that funding provided under this initiative has not been used for any of the items listed in Section 7 of the hospital working funds accountability agreement. Hospital CEO (print name) Hospital CEO (signature) Dated Hospital Board Chair (print name) Hospital Board Chair (signature) Dated 11. LHIN Approval (LHIN use only) LHIN CEO (print name) LHIN CEO (signature) Dated LHIN Board (print name) LHIN Board (signature) Dated Hospital completed Report should be returned to Due to LHIN 45 days after quarter end [ LHIN insert who] Once LHIN Board Approved, return completed Report to Steffie.Anastasopoulos@ontario.ca Due 75 days after quarter end 153

86 154

87 Resolution North East Local Health Integration Network (the Corporation ) Motion No.: 2013-BD0016 Moved by: Seconded by: Thursday, August 22, 2013 RESOLVED THAT: The Board of Directors receive and approve the Sault Area Hospital Working Funds report. Elaine Pitcher Chair 155

88 HOSPITAL WORKING FUNDS INITIATIVE QUARTERLY REPORT HOSPITAL NAME Timmins and District General Hospital 0907 For fiscal year: 2012/ /14 x 2014/15 For the Quarter ending: June x Sept December March Submission Date Hospital to LHIN: 45 days after quarter end (Q1 - August 14, Q2 - November 14, Q3 - February 14, Q4 - May 15) Submission Date LHIN to Ministry: 75 days after quarter end (Q1 - September 13, Q2 - December 14, Q3 - March 16, Q4 - June 14) Financial Report 1. Annual Balanced Budget (HSAA definition) (actuals per audited financial statements) restated Actual Actual Forecast 2011/ / /14 Revenues 98,098, ,257, ,000,000 Expenses 100,834,677 98,495, ,000,000 HSAA definition Surplus/(Deficit) (2,736,002) 1,761,634 0 Using the HSAA definition, is the hospital forecasting a balanced Budget for 2013/14? Yes X No Does this forecast include the 2013/14 Working Funds remedy funding? Yes No X 2. Adjusted Working Funds Deficit (actuals per audited financial statements and MIS) restated Actual Actual Forecast 2011/ / / Current Assets 5,009,871 4,569,911 4,500, Unrestricted or internally restricted long-term investments Portion of externally restricted long-term investments that is NOT restricted (eg. Interest) Externally restricted cash and cash equivalents reported in current assets Externally restricted investments reported in current assets Externally restricted receivables reported in current assets Trust or research funds not included in current assets that are available to operations Other non-current assets not externally restricted available for working funds Other adjustments to working funds not previously reported above 2.10 Adjusted Current Assets 5,009,871 4,569,911 4,500, Current Liabilities 18,473,011 15,750,598 14,400, Total vacation accrual (3,705,569) (3,651,087) (3,700,000) Cash payouts for terminations and retirements 222, , ,000 (6% assumption - calculated) Vested sick leave accruals in current liabilities Average annual payout from vested sick bank Callable debt and short-term debt that is deemed to be long-term in nature Current portion of long-term debt not already in current liabilities Any current liability associated with 2.4, 2.5, & Other adjustments to working funds not previously reported above 2.20 Adjusted Current Liabilities 14,989,776 12,318,576 10,922, Adjusted Working Funds Deficit (A) (9,979,905) (7,748,665) (6,422,000) Amount Per Hospital Working Funds Accountability Framework Agreement (7,081,220) SHORTFALL (if any) 0 156

89 HOSPITAL WORKING FUNDS INITIATIVE QUARTERLY REPORT HOSPITAL NAME Timmins and District General Hospital 0907 For fiscal year: 2012/ /14 x 2014/15 For the Quarter ending: June x Sept December March Submission Date Hospital to LHIN: 45 days after quarter end (Q1 - August 14, Q2 - November 14, Q3 - February 14, Q4 - May 15) Submission Date LHIN to Ministry: 75 days after quarter end (Q1 - September 13, Q2 - December 14, Q3 - March 16, Q4 - June 14) Financial Report Plan to Correct Shortfall by March 31, Adjusted Working Funds Deficit/Total Revenue % (actuals per audited financial statements) Actual Actual Forecast 2011/ / /14 Total Revenues 100,182, ,549, ,000,000 Adjusted Working Funds Deficit from Above (A) (9,979,905) (7,748,665) (6,422,000) Adjusted Working Funds Deficit/Total Revenue % -9.96% -7.56% -6.42% Percentage Per Hospital Working Funds Accountability Framework Agreement -7.07% SHORTFALL (if any) 0.0% Plan to Correct Shortfall by March 31, Cash Advance Actual Actual Forecast 2011/ / /14 Cash Advance Amount (Before Year End Bridging) - 5,000,000 3,970,000 Note: The 2013/14 Year 3 funding remedy should be excluded from the 2013/14 forecast of the cash advance. Cash Advance Per Hospital Working Funds Accountability Framework Agreement 2,768,760 SHORTFALL (if any) (1,201,240) 5. Current Ratio (Current Assets/Current Liabilities) (automatically calculated from data above) restated Actual Actual Forecast 2011/ / /14 Current Assets 5,009,871 4,569,911 4,500,000 Current Liabilities 18,473,011 15,750,598 14,400,000 Current Ratio Is Current Ratio Improving? Yes X No 157

90 HOSPITAL WORKING FUNDS INITIATIVE QUARTERLY REPORT HOSPITAL NAME Timmins and District General Hospital 0907 For fiscal year: 2012/ /14 x 2014/15 For the Quarter ending: June x Sept December March Submission Date Hospital to LHIN: 45 days after quarter end (Q1 - August 14, Q2 - November 14, Q3 - February 14, Q4 - May 15) Submission Date LHIN to Ministry: 75 days after quarter end (Q1 - September 13, Q2 - December 14, Q3 - March 16, Q4 - June 14) Financial Report 6. Adjusted Working Funds Current Ratio (automatically calculated from data above) restated Actual Actual Forecast 2011/ / /14 Adjusted Current Assets 5,009,871 4,569,911 4,500,000 Adjusted Current Liabilities 14,989,776 12,318,576 10,922,000 Adjusted Current Ratio Is Adjusted Current Ratio Improving? Yes X No If NO then provide plan to correct 7. Debt Ratio (Total Liabilities/Total Assets) (actuals per audited financial statements) restated Actual Actual Forecast 2011/ / /14 Total Assets 70,401,221 65,636,277 65,300,000 Total Liabilities 82,519,673 76,416,308 75,100,000 Debt Ratio Is Debt Ratio Improving? Yes X No If NO then provide plan to correct /14 Working Funds Remedy Uses Please provide a brief description of the proposed uses for the 2013/14 Working Funds Remedy funding. Reduction of cash advance/operating line of credit 158

91 HOSPITAL WORKING FUNDS INITIATIVE QUARTERLY REPORT HOSPITAL NAME Timmins and District General Hospital 0907 For fiscal year: 2012/ /14 x 2014/15 For the Quarter ending: June x Sept December March Submission Date Hospital to LHIN: 45 days after quarter end (Q1 - August 14, Q2 - November 14, Q3 - February 14, Q4 - May 15) Submission Date LHIN to Ministry: 75 days after quarter end (Q1 - September 13, Q2 - December 14, Q3 - March 16, Q4 - June 14) Financial Report Approvals and Contact 9. Hospital Contact Info Contact's name: Bryan Bennetts Contact's position: Chief Financial Officer Contact's telephone number: Contact's bbennetts@tadh.com Contact's fax number: Date (dd-mm-yy) 06-Aug-13 Please provide any additional comments below: Re: # Expenses exclude costs being incurred on a temporary basis to provide care to ALC and other patients in-hospital while waiting for the opening of new LTC beds in the community. 159

92 HOSPITAL WORKING FUNDS INITIATIVE QUARTERLY REPORT HOSPITAL NAME Timmins and District General Hospital 0907 For fiscal year: 2012/ /14 x 2014/15 For the Quarter ending: June x Sept December March Submission Date Hospital to LHIN: 45 days after quarter end (Q1 - August 14, Q2 - November 14, Q3 - February 14, Q4 - May 15) Submission Date LHIN to Ministry: 75 days after quarter end (Q1 - September 13, Q2 - December 14, Q3 - March 16, Q4 - June 14) Financial Report 10. Approvals and Attestation - Funding Restrictions Hospital CEO and Board Chair have reviewed and hereby approve the above quarterly report. Hospital CEO and Board Chair attest that funding provided under this initiative has not been used for any of the items listed in Section 7 of the hospital working funds accountability agreement. Hospital CEO (print name) Roger N Walker Hospital CEO (signature) Dated 06-Aug-13 Hospital Board Chair (print name) Léon Laforest Hospital Board Chair (signature) Dated 06-Aug LHIN Approval (LHIN use only) LHIN CEO (print name) LHIN CEO (signature) Dated LHIN Board (print name) LHIN Board (signature) Dated Hospital completed Report should be returned to Due to LHIN 45 days after quarter end [ LHIN insert who] Once LHIN Board Approved, return completed Report to Steffie.Anastasopoulos@ontario.ca Due 75 days after quarter end 160

93 161

94 Resolution North East Local Health Integration Network (the Corporation ) Motion No.: 2013-BD0017 Moved by: Seconded by: Thursday, August 22, 2013 RESOLVED THAT: The Board of Directors receive and approve the Timmins and District Hospital Working Funds report. Elaine Pitcher Chair 162

95 North East LHIN Briefing Note North East Specialized Geriatric Services (NESGS) Integration with North Bay Regional Health Centre (NBRHC) July 30, 2013 Issue(s) The City of Greater Sudbury (as the operator of the Pioneer Manor long-term care home) and North Bay Regional Health Centre are proposing a voluntary integration under section 27 of the Local Health Services Integration Act whereby the sponsorship of the North East Specialized Geriatric Services will transfer from Pioneer Manor/CGS to the NBRHC effective September 30, Background and Context Given its leadership in recruiting and supporting the region s first geriatrician in 2009, the City of Greater Sudbury (through Pioneer Manor) has been the NE LHIN Health Service Provider receiving funding to develop and deliver specialized geriatric services across the region. This has been achieved through the establishment of a multi-disciplinary team funded by the NE LHIN to support the geriatrician s medical specialist role located at the Seniors Centre of Excellence in Sudbury. The program staff also travels to communities throughout the North East and uses OTN extensively to further extend its reach in the North East. As the program has matured over the past four years, in 2012 the CGS requested that the LHIN find a new sponsor more in keeping with the health service and regional roles of the NESGS. In the falloff 2012 an open process, supported by a multi-stakeholder project team, was undertaken to seek organizations with an interest in, and ability to, sponsor the NESGS. Clear expectation and requirements of a sponsor were developed and communicated through this process. The project team recommended that NBRHC become the future sponsor. This is aligned clinically with a number of NBRHC s seniors programs (e.g. senior s mental health, BSO) and its regional presence/mandate. Financial Information The NE LHIN currently funds the NESGS at $1.37M per year. This funding will be redirected from Pioneer Manor (CGS) to NBRHC on September 30, Key Messages No services will change at the NESGS as a result of this change. The transfer of NESGS sponsorship to NBRHC allows for clinical and organizational efficiencies and opportunities for the program that will allow it to further develop as a specialized medical service. Significant engagement has been undertaken throughout the process plan for a new program sponsor. There is widespread support for this direction. The head office of NESGS will be maintained in the City of Greater Sudbury, and for the time being at the current Pioneer Manor site. Page 1 of 2 163

96 The new sponsorship model also includes defined and clearly articulated roles for the program, NBRHC as sponsor, NE LHIN as funder, and a new regional geriatrics steering committee (to be established in the fall of 2013) that will be responsible for planning and coordinating specialized geriatrics services across the region. The NE LHIN is being asked to support this integration request to proceed. Next Steps Both the NBRHC and CGS have passed motions supporting the transfer of NESGS sponsorship (attached). That the NE LHIN pass the following Motion at their August 22, 2013 meeting: WHEREAS in compliance with section 27 (3)(a) of the Local Health System Integration Act, 2006, the health service provider shall give notice to the LHIN of any integration that relates to services that are funded, in whole or in part, by the LHIN; AND WHEREAS the NE LHIN was advised by the North East Specialized Geriatric Services, North Bay Regional Health Centre and City of Greater Sudbury on July 26, 2013 of their intent to proceed with integration; THEREFORE BE IT RESOLVED THAT pursuant to subsection 27(3)(a) of the Local Health System Integration Act, 2006 (LHSIA), North East Specialized Geriatrics Services submitted to the NE LHIN a Notice of Intended Integration to integrate NESGS with NBRHC effective September 30, This means that the North Bay Regional Health Centre will become the new sponsor of the North East Specialized Geriatric Services effective September 30, 2013 with pertinent service accountability agreements to be amended accordingly. Author(s) Philip Kilbertus, Senior Officer Page 2 of 2 164

97 NOTICE OF INTENDED INTEGRATION UNDER SECTION 27 OF THE LHSIA: HEALTH SERVICE PROVIDER CHECKLIST Section 27(3)(a) of the Local Health System integration Act (the Act ) requires a health service provider ( HSP ) to give notice to a LHIN of any integration that relates to services that are funded, in whole or in part, by the LHIN. Unless otherwise advised by the LHIN in writing, a notice of intended integration under s. 27 of the LHSIA should include the information set out below. This information is requested under s. 22 of the Act to ensure that the LHIN has sufficient information to enable it to determine whether the proposed integration should proceed. Please ensure that you attach all relevant information. Identify and describe the health service provider(s) involved. NORTH EAST SPECIALIZED GERIATRIC SERVICES- City of Greater Sudbury Since 1990 the Master Plan for the City of Greater Sudbury included provisions for the development of services that were designed to meet the demand for more specialized medical geriatric services. The knowledge of the growing demographic of older adults in our community was the impetus to the development of the inclusion of this population in the master plan. In Northern Ontario the population of older adults is higher than the provincial average. Through the development of different initiatives led by the City of Greater Sudbury Community Development department, the site of Pioneer Manor is recognized as the Seniors Campus and a Centre of Excellence for Northern Ontario. Alongside Pioneer Manor this site also provides space to Alzheimer s Society Sudbury/Manitoulin, City of Lakes Family Health Team, and North East Specialized Geriatric Services. Through the vision and leadership of the City of Greater Sudbury, Dr. Jo-Anne Clarke was recruited to lead North East Specialized Geriatric Services. Through generous support and funding from the City of Greater Sudbury Dr. Clarke was the first Geriatrician in Northeastern Ontario. Dr. Clarke established a specialized, interdisciplinary practice that would offer assessment and treatment of older adults, build capacity amongst other health care providers and provide professional advice on the continuum of care across the North East. Through financial support and guidance the North East Local Health Integration Network has been a key partner. The funding through the Aging at Home allocations has supported the implementation of the Specialized Geriatric Services. North East Specialized Geriatric Services (NESGS) offers specialized care for older adults with complex health needs and expert resources for caregivers and health care professionals across the North East / 9

98 Services are delivered with a patient-centred, interdisciplinary approach with health care professionals from various backgrounds. Assessment and treatment services are provided by the following disciplines: Geriatrician Care of the Elderly Physician Nurse Practitioner Geriatric Nurse Clinicians Physio Therapy Occupational Therapy Social Work The goals of NESGS are to provide specialized geriatric assessment and treatment, to provide education, knowledge transfer and capacity building, and to be responsive to the specialized medical needs of older adults in Northern Ontario. The specific services of NESGS include ambulatory clinic consultations, Home Visits, Telemedicine consultations and regional outreach. Identify and describe all other entities involved. NORTH BAY REGIONAL HEALTH CENTRE The North Bay Regional Health Centre (NBRHC) is a unique healthcare organization with three primary roles. It provides acute care services to North Bay and its surrounding communities, it is the district referral centre providing specialist services for smaller communities in the area, and it is the specialized mental health service provider serving all of northeast Ontario NBRHC has 420 beds and numerous outpatient and outreach services in North Bay, Sudbury and throughout the northeast region. NBRHC is one of four major acute care hospitals serving northeast Ontario; the others being Sault Area Hospital, Timmins and District Hospital and Health Sciences North (Sudbury). The area is also served by small community hospitals like Mattawa and West Nipissing General hospitals. NBRHC s Regional Mental Health Services provides inpatient beds in North Bay and Sudbury and outpatient and outreach services that throughout the region from Hudson Bay to Muskoka from Sault Ste. Marie to the Quebec border. A major teaching centre for students in medicine, psychiatry, nursing and allied health professions, NBRHC is proud to be affiliated with the Northern Ontario School of Medicine, Nipissing University, Canadore College and several other Ontario colleges and universities. North Bay Regional Health Centre is chairing the development of a regional Academic Health Science Research Network to better address the unique needs of the north and overcome barriers / 9

99 that impact academic health care. The Academic Health Science Research Network will try to ensure the translation of knowledge into innovative healthcare solutions. Describe the intended integration, including specific timing and dates. DESCRIPTION OF INTENDED INTEGRATION As a result of the leadership and support of both the City of Greater Sudbury and the North East LHIN, North East Specialised Geriatric Services (NESGS) has matured to a point of sustainability and is positioned for significant growth. In mid 2012 a decision was made by City of Greater Sudbury to undertake a process to seek a new host organization and governance model for NESGS. It was recognized by the City of Greater Sudbury and North East Specialized Geriatric Services that the evolution of specialized geriatric services across the North East would mean considerable growth for the program and as such it would be better positioned within a health care environment. Specific criteria for the new host organization were established by a project team led by the North East LHIN and the City of Greater Sudbury. In January of 2013 following a call for proposals, the North East LHIN accepted a recommendation by the project team to designate the North Bay Regional Health Centre as the host agency for NESGS. The decision made by the project team recognized the specialized services of the North Bay Regional Health Centre and the long standing presence at the Kirkwood site in Sudbury. The decision to secure a hospital as the new sponsor reflects the standard for Specialized Geriatric Services across the province / 9

100 Integration timelines: Date Activity Responsible party June 26, 2013 NBRHC Board passes motion to accept the transfer of NESGS NBRHC Board of Directors Purpose NBRHC Board accepted that NBRHC be the sponsor of NESGS that was won through an RFP process through the NE LHIN July 9, 2013 City Council meeting City of Greater Sudbury/North East Specialized Geriatric Services To approve transfer of program to North Bay Regional Health Centre. July 26, 2013 Send NE LHIN Integration package North East Specialized Geriatric Services North East LHIN receives notice of integration transfer motions from both Sudbury city council to give SGS program up, and from NBRHC that they are willing to receive, and then NE LHIN board has up to 60 days to either issue opposition or allow to proceed August 22 NE LHIN Board Meeting NE LHIN Consent for integration to proceed Sept. 30 Transfer is finalized NBRHC can confirm transfer to its employees via newsletter Internal Stakeholders Employee awareness October 1 NBRHC website hosts NE SGS materials External stakeholders Information Link to be provided by NE LHIN to all HSPs HSPs To prepare for the transition from the City of Greater Sudbury to the recommended sponsor, North Bay Regional Health Centre the expectations were clearly outlined as follows: Sponsor Agency: To provide operational support, including human resources, payroll, financial reporting, information technology, office space and other supports appropriate to the needs of a regional program. To collaborate with the North East LHIN and NESGS in the development of a new regional governance structure / 9

101 To participate as an equal member of the regional structure. It is understood that the host agency will not hold any additional authority over the regional specialised geriatric services system. To participate in the recruitment and selection of the Executive Director and Medial Director, as an equal member of the NESGS Steering Committee. To collaborate with the NESGS Leadership Team ( Medical Director & Executive Director) to operate within the approved budget as directed by North East LHIN and the regional governance authority BACKGROUND & BUSINESS CASE Provide an environmental scan. The scan will profile population health, provide an inventory of the available resources and assess need and system capacity as relates to the indeed integration. The demographic imperative: Previously unimagined numbers of people are living over the age of 65. Just after the turn of the century, in Canada, just under 5% lived to >65, and now 14%, projected to reach 23% by 2041, the largest growth in the >85 group, -Dr. Jo-Anne Clarke. In the North East the population 65+ is greater than the rest of province, there is a high ratio of ALC patients in our hospitals, ranging from 8% to 30%. The population in the North East region also has a higher percentage of daily smokers and adults who are obese. According to regional statistics approximately 7,700 people have been diagnosed with Alzheimer disease or a related dementia / 9

102 In the North East we are constantly challenged with the ALC Alternate Level of Care rates in the acute care hospitals. A key outcome of the North East Specialized Geriatric Services is to keep older adults from the unnecessary upward substitution of care by providing assessment and treatment of chronic conditions. Other available resources for specialized services include the Community Support Services provided by the Alzheimer s Society chapters in the North East, the district level Seniors Mental Health programs and the Regional Seniors Mental Health programs. In addition high risk seniors are supported by CCAC Complex Care Coordinators. The regional specialized dementia beds operated by NBRHC and the Behavioural Supports for the North East support the population of older adults needing specialized care and are services that are complimentary to NE SGS. The multiple community health services providers makes it challenging to support older adults to navigate the system so they can remain in their home with support. This integration will lead to increased common assessment processes, reduced duplication and increased inter organizational practices. To sustain specialized geriatric services and system requires appropriate clinical compensation in order to attract and retain professionals. Identify any community engagement and/or consultation that occurred and describe the outcome (e.g., results of any engagement activities; specific groups or populations engaged; methods of engagement used; evidence of community/stakeholder support). To facilitate this voluntary integration the City of Greater Sudbury worked alongside the North East LHIN to develop a process for selecting a new program sponsor using a competitive bid under a request for proposals. Through the City of Greater Sudbury NE SGS Advisory panel the decision to seek a new sponsor was reviewed and supported. From the Advisory panel discussions a project team was created. The selection process was guided by a project team consisting of a physician from a family health team in Temiskaming, a representative from the Sault Area Hospital, City of Greater Sudbury, a consumer and expert clinicians from the North East Specialized Geriatric Services. The project team worked to ensure that the interests of older adults were kept at the forefront as well as the need to ensure that the successful sponsor had a strong regional mandate for specialized care / 9

103 As part of the response to the request for proposals North Bay Regional Health Centre received letters of support from: Canadian Mental Health Association Cochrane/Temiskaming Alzheimer Society Sault Ste. Marie And Algoma District Alzheimer Society North Bay And District Community Mental Health Service Muskoka/Parry Sound Hearst Kapuskasing Smooth Rock Falls Counseling Services Doctor Marie-France Rivard, Ontario Psychiatric Outreach Program Provide a business case that identifies and assesses the economic benefits, risks and opportunities of the proposed integration. The business case should also explain how the proposed integration will: (i) be financed; (ii) promote efficient and effective use of resources; and (iii) contribute to system sustainability. Older adults that have complex, medical needs will benefit from the alignment between North Bay Regional Health Centre and the North East Specialized Geriatric Services as access to tertiary care will be streamlined. The ability to share expertise with health care providers across the North East will be enhanced. Transitioning from a municipal sponsor to a regional environment with a medical focus will increase the ability of NE SGS to share geriatric expertise across the north. As a result of the change in sponsor to the North Bay Regional Health Centre, NESGS will become part of a health care facility. NESGS staff will have access to the most up-to-date training, policies and standards of care. Patients of NESGS will also have better access to programs and services as efficiencies in the health care system throughout the region are realized. As of April 1, 2013 the NE LHIN provides $1.37 M in funding for North East Specialized Geriatric Services. The current funding will transfer over with the program, additional funding is being requested in order to fulfill the regional mandate of NE SGS and provide for consistent practice of geriatrics in the North East. SUSTAINABILITY: The affiliation with North Bay Regional Health Centre will support the regional mandate of the program as well as position the program to greater fulfill the mandate of education, program and system development and research. PUBLIC INTEREST CONSIDERATIONS Explain how the proposed integration is in the public interest. In doing so, indicate how the proposed integration: (i) will result in the provision of appropriate, coordinated, effective and efficient health services; (ii) supports the achievement of the goals of the IHSP or the / 9

104 Provincial Strategic Plan; and (iii) improves the quality of services, patient care and access. This proposed integration will facilitate improved patient care through the strategic alignment with geriatric psychiatry programs, by providing increased educational opportunities through NOSM and closer clinical alignments with BSO and Seniors Mental Health. From the perspective of system improvements the development of the new regional governance structure for NESGS will reposition the program to take on the following mandate: Advise and facilitate the implementation of the Integrated Health Services Plan (IHSP) of the North East LHIN and the Provincial Seniors Strategy on issues related to specialized seniors care and geriatric services. Provide leadership in the creation of a regional system of integrated specialized geriatric services for frail seniors including system planning, clinical practice, system resourcing recommendations, monitoring of performance outcomes, advocacy, communication and education for SGS in the North East LHIN. Recommend evidence-based best practice standards, guidelines and benchmarks for SGS to local providers and networks across the North East. Leverage current investments for specialized geriatric services as a means to facilitate the spread of innovation and support improved access to SGS across the North East. Review and promote proposals for new specialized geriatric services funding to the North East LHIN. Promote education, research and dissemination of best/promising practices in specialized care of frail seniors. Engage in stakeholder consultation related to frail seniors and ensure strong linkages with local SGS-related providers and networks across the region. Identify and assess other potential impacts of the proposed integration. In doing so, consider impact(s) on the population of the LHIN, specific sub-populations, labour and employment relations, volunteers, other health service providers or organizations providing services in LHIN and the governments and organizations that provide funding to the HSPs. Human Resources It is expected that employees of the City of Greater Sudbury will be transferred to the new sponsor effective September 30, The program transfer will be guided by key principles which includes the ethical treatment of employees. The commitment from North Bay Regional Health Centre includes: / 9

105 Minimal disruption of the workforce and ensure that client care needs remain the focus of the program outcomes A transparent process with weekly communication. Staff input will be sought when possible and transfer negotiations will adhere to the defined principles agreed to by the City of Greater Sudbury and North Bay Regional Health Centre. Program location The regional head office of NESGS will remain in the City of Greater Sudbury, and currently at the Pioneer Manor site of North East Centre of Excellence for Seniors Health. APPROVALS For each party to the proposed integration, provide a certified copy of the board s or, in the case of a partnership, the partners, resolution approving the proposed integration as described in the notice. DATE AND CONTACT INFORMATION July 26, 2013 Valerie Scarfone Executive Director North East Specialized Geriatric Services 960-D Notre Dame Avenue Sudbury, ON P3A 2T4 (705) ext 3282 For NE LHIN Internal Use: / 9

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109 Resolution North East Local Health Integration Network (the Corporation ) Motion No.: 2013-BD0018 Moved by: Seconded by: Thursday, August 22, 2013 RESOLVED THAT: WHEREAS; In compliance with section 27 (3)(a) of the Local Health System Integration Act, 2006, the health service provider shall give notice to the LHIN of any integration that relates to services that are funded, in whole or in part, by the LHIN; WHEREAS; The NE LHIN was advised by the North East Specialized Geriatric Services (NESGS) on Friday, July 26, 2013 of their intent to divest to the North Bay Regional Health Centre (NBRHC); WHEREAS; Since 2007, the City of Greater Sudbury has been the sponsor of NESGS; WHEREAS; A Request for Proposal was initiated in the fall of 2012 and the result led to the selection of NBRHC as the new program sponsor; WHEREAS; The NBRHC passed a motion on June 26, 2013 approving the acceptance of the sponsorship of NESGS; WHEREAS: The Council of the City of Greater Sudbury on August 9, 2013 passed a motion to support the transfer of the NESGS to the North Bay Regional Health Centre; WHEREAS; The regional head office of NESGS will remain in the City of Greater Sudbury, at the Pioneer Manor site; WHEREAS; There will be no disruption of services and that client care needs remain the focus of the program outcomes; BE IT RESOLVED; Upon the NE LHIN s review of the Section 27 notice, the Board of Directors will not stop the voluntary integration request. The NBRHC will be responsible to assume all costs associated with the divestment process. The target date to complete the integration is September 30, {Carried} Elaine Pitcher Chair 177

110 1. Date: August 25, Parties to Decision: Backgrounder Coming Together Integration Iris Addiction Recovery for Women and Rockhaven Integration Sudbury Addiction Treatment Program transfer of funds The following organizations are in agreement with the decision: Iris Addiction Recovery for Women Rockhaven Sudbury Addiction Treatment Program ( Salvation Army) 3. Facts: The above organizations, in agreement to this decision, are publicly funded health service providers. Iris Addiction Recovery for Women provides a range of community and residential addictions services for women in the City of Greater Sudbury and surrounding area. Rockhaven provided residential addiction treatment to men in the City of Greater Sudbury and surrounding area. Salvation Army provides residential addiction treatment to men in the City of Greater Sudbury and surrounding area. The purpose of the proposed integration is to realign the following addiction programs and funding. Rockhaven and Iris Addiction Recovery for Women will integrate creating new entity within current letters of incorporation. A funding transfer from Salvation Army to the new entity will occur. 4. Process Program Funding Case Management $530,000 Addiction Treatment $90,000 Initial Assessment and Treatment Planning $160,000 Addiction Home Care $120,000 Residential Addictions $1,030,000 Total Funding $1,930,000 The potential for integration between the three community addiction programs was identified during a meeting with addiction services providers in February The agencies struck The Coming Together Integration Steering Committee with four members from each organization (2 staff and 2 board members each). With the assistance of a consultant the steering committee has developed a detailed work plan to achieve the project s objective to explore viable opportunities for integration and increased collaboration and to develop a detailed integration implementation plan which includes the following work activities; 11 02B1 Issue Note - Notice of Intended Integration Rockhaven, Iris, Salvation Army.docx 1 178

111 Establish communication plan Review agency documentation, policies and procedures Organize, coordinate and summarize a comprehensive stakeholder consultation process Identify key findings and prepare summary recommendations for achieving integration Develop an implementation action plan Prepare summary report to be submitted to NELHIN On June 19, 2013 Iris Addiction Recovery for Women Board of Directors passed a motion to integrate with Rockhaven. On June 27, 2013 Rockhaven Board of Directors passed a motion to integrate with Iris Addiction Recovery for Women. During Ontario Great Lakes Divisional Executive Board meeting for Salvation Army supported the proposal to transfer funding to new entity. On July 17, 2013 the NE LHIN received the Section 27, Intent to Integrate from Iris Addiction Recovery for Women and Rockhaven and funding transfer from Salvation Army. Since June 2012, extensive consultation has taken palace with various stakeholders regarding the integration of the programs. These groups/individuals included: Boards of Directors and staff of each organization Public Health Unit Health Sciences North Methadone Programs Canadian Mental Health Association ( Sudbury) Shkagamik Kwe Health Centre N Swakamok Native Friendship Centre Corrections Canada Access Network Funders United Way, NE LHIN, and First Nations & Inuit Health Branch Six integration priorities were identified through the consultation process; governance, administration, service delivery, capital infrastructure, challenges & barriers and system issues Thirty two recommendations were developed to move the integration process forward; these recommendations are outlined in a summary report which is the integration implementation plan. 5. Analysis of Intended Integration Integration of addiction services is supported by the NE LHIN Operational Plan and several MOHLTC and provincial reports. The integration of addiction programs will result in efficiencies and enhanced programming for direct care with residual resources. The proposed integration will ensure both the quality and long-term sustainability of the local addiction system B1 Issue Note - Notice of Intended Integration Rockhaven, Iris, Salvation Army.docx 2 179

112 6. Decision The NE LHIN Board of Directors is asked to review Section 27 and provide decision to not stop the voluntary integration request B1 Issue Note - Notice of Intended Integration Rockhaven, Iris, Salvation Army.docx 3 180

113 NOTICE OF INTENDED INTEGRATION UNDER SECTION 27 OF THE LHSIA: HEALTH SERVICE PROVIDER CHECKLIST Section 27(3)(a) of the Local Health System integration Act (the Act ) requires a health service provider ( HSP ) to give notice to a LHIN of any integration that relates to services that are funded, in whole or in part, by the LHIN. Unless otherwise advised by the LHIN in writing, a notice of intended integration under s. 27 of the LHSIA should include the information set out below. This information is requested under s. 22 of the Act to ensure that the LHIN has sufficient information to enable it to determine whether the proposed integration should proceed. Please ensure that you attach all relevant information. DESCRIPTION OF INTENDED INTEGRATION Iris Addiction Recovery for Women and Rockhaven wish to merge into a new entity and transfer addiction funding from The Salvation Army New Life Centre to the new entity. New entity combining Rockhaven and Iris Addiction recovery for Women will be established by March 2014 Negotiation for new MSAA bringing funding and services together will commence January 2014 and completed by March 31, Funding transfer from Salvation Army to Iris Addiction recovery for Women will be complete November 1, ( No board action required for information only) BACKGROUND & BUSINESS CASE In the summer of 2012, Iris Addiction Recovery for Women, Rockhaven Recovery, and the Salvation Army (Addictions Rehabilitation Program) came together formally to explore ways in which they could utilize their collective resources to enhance service delivery to clients Some of the benefits of this integration will be; new model of care to support streamlined client access, common intake, treatment planning and evaluation of outcomes. enhanced and uniform quality of service for both men and women, improved access and system navigation for consumers and their families opportunity for administrative efficiencies, such as payroll, HR, IT and one ED development of capital plan to improve current physical space, It was agreed that the scope of the Steering Committee s work would be focused on exploring and identifying integration opportunities specific to governance, administration, service delivery and physical plant. Services Offered Agency Programs offered Staffing Facility Rockhaven Supportive Housing. After Care residence (rent geared-to- 10 staff SH 18 beds, AC residence 6 beds 181

114 $500,000 income), Summer camp on Lake Geneva All 3 properties are paid in full and owned by the organization. Neither site is wheelchair accessible Iris Addiction Recovery for Women $1,600,000 The Salvation Army Addictions Rehab Program $535,000 Iris Treatment: 35 day residential and day treatment program 1 week recovery enhancement program Connections program Pregnancy Parenting Outreach Program Women For Sobriety Iris Aftercare Outpatient programming as well as rent geared-to-income residence Addictions Supportive Housing HSN Emergency Department Substance Abuse Workers Aboriginal After Care Program Families in Recovery Weekend Mother/Daughter Weekend Residential Program a week, 11 beds 38 staff Treatment - 12 beds AC - two 4 bedroom apartments Both sites are wheelchair accessible 6 staff 11 beds for addictions clients as well as offices and a joint meeting room for clients and staff. Site is not wheelchair accessible Stakeholder Consultation Clients, Boards of Directors, Executive Directors and staffs of each agency Sudbury & District Public Health, HSN Addictions, Mental Health & Gambling, HSN Emergency Department, Shkagamik-Kwe Health Centre, Access Network; NE LHIN PUBLIC INTEREST CONSIDERATIONS Summary Recommendations (as a result of stakeholder consultations): 1. That a new corporate entity be established within 7 months. 2. That this new corporation be governed by a 9 member Board of Directors composed of representatives from Rockhaven, Iris, Salvation Army and 4 new representatives from the community. 3. That the new entity establish a formal service agreement (contract) with the Salvation Army consistent with the current MultiSectoral Service Agreement with the NELHIN. 4. We are also meeting with HSN to discuss the Withdrawal Management Services and how they might fit into the new structure. 182

115 5. That the new organization contract the services of a human resources professional to set up a comprehensive human resources management system and to ensure compliance with relevant provincial and federal employment and labour standards/regulations. 6. That this newly integrated entity serve as a hub for training, professional development and research in Northern Ontario and work towards becoming a Centre of Excellence for best practices in delivering community-based substance abuse services. 7. That the new model develops core competencies, training standards and requisite minimum credentials for all staff involved in providing services to clients. 8. Given the age, lack of current space, limited accessibility and costs involved in on-going retrofitting and maintenance of existing buildings, that the new entity explores the viability of constructing new facilities in Sudbury to house and treat both women and men. In collaboration with HSN Withdraw management services and North East Local Health Integration Network (NELHIN) to proceed with capital reconstruction and/or relocation in or near the downtown core of the City of Greater Sudbury. A capital plan could be developed in year 1 with a target date of 2-3 years for achieving a new space option for the integrated operation. 9. Once the Integration Implementation Plan has been approved, that a series of information and exchange sessions be coordinated with the pool of frontline staff from each service delivery site to identify service priorities, best practices and approaches to care/treatment and to resolve any outstanding or contentious issues pertaining to perceived differences in organizational culture, philosophy and values. 10. That the new entity initiate dialogue and formal partnership with Shkagamik-Kwe Health Centre and other First Nation organization to enhance referral, coordination and provision of care for aboriginal clients within the community. This Integration Implementation Plan is a critical step in consolidating resources and unifying the efforts of board members, staff and volunteers towards enhancing residential addiction services for women and men in and beyond the Sudbury/Manitoulin Districts. We anticipate it will improve and/or streamline client service and develop a more integrated model of service in order to provide an easier navigation of services from the client perspective. With dedicated leadership, commitment and collaboration it should also serve as a catalyst for continued integration of programs and services which enhance the continuum of care for clients in the community. APPROVALS Name, Chair of Iris Addiction Recovery for Women: Susan Schuster sschuster@vianet.ca Phone Number: Name, Executive Director / CEO of Rockhaven: Richard Picard richard.picard@scotiabank.com Phone: , x 7502 Name, Salvation Army Advisory Board Representative: Richard Van Oort vanoort@regentfinancial.ca Phone Number: For NE LHIN Internal Use: 183

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119 Resolution North East Local Health Integration Network (the Corporation ) Motion No.: 2013-BD0019 Moved by: Seconded by: Thursday August 22, 2013 WHEREAS in compliance with section 27 (3)(a) of the Local Health System Integration Act, 2006, the health service provider shall give notice to the LHIN of any integration that relates to services that are funded, in whole or in part, by the LHIN; AND WHEREAS the NE LHIN was advised by the Iris Addiction Recovery for Women and Rockhaven on July 19, 2013 of their intent to proceed with integration; THEREFORE BE IT RESOLVED THAT pursuant to subsection 27(3)(a) of the Local Health System Integration Act, 2006 (LHSIA), Addiction Steering Committee submitted to the NE LHIN a Notice of Intended Integration to integrate Rockhaven with Iris Recovery for Women. The organizations will be responsible to assume legal costs associated with the integration process. Elaine Pitcher Chair 187

120 THIS AMENDING AGREEMENT (the Agreement ) is made as of the 1 st day of October, 2013 B E T W E E N: AND XXX LOCAL HEALTH INTEGRATION NETWORK (the LHIN ) [Legal Name of the Hospital] (the Hospital ) WHEREAS the LHIN and the Hospital (together the Parties ) entered into a hospital service accountability agreement that took effect April 1, 2008 (the H-SAA ); AND WHEREAS pursuant to various amending agreements the term of the H-SAA has been extended to September 30, 2013; AND WHEREAS the LHIN and the Hospital have agreed to extend the H-SAA for a further six-month period with the joint intention of finalizing and executing an H-SAA for the period April 1, 2013 March 31, 2016; NOW THEREFORE in consideration of mutual promises and agreements contained in this Agreement and other good and valuable consideration, the parties agree as follows: 1.0 Definitions. Except as otherwise defined in this Agreement, all terms shall have the meaning ascribed to them in the H-SAA. References in this Agreement to the H-SAA mean the H-SAA as amended and extended. 2.0 Amendments. 2.1 Agreed Amendments. The H-SAA is amended as set out in this Article Term. The reference to September 30, 2013 in Article 3.2 is deleted and replaced with March 31, Effective Date. The amendments set out in Article 2 shall take effect on October 1, All other terms of the H-SAA shall remain in full force and effect. 4.0 Governing Law. This Agreement and the rights, obligations and relations of the Parties will be governed by and construed in accordance with the laws of the Province of Ontario and the federal laws of Canada applicable therein. 5.0 Counterparts. This Agreement may be executed in any number of counterparts, each of which will be deemed an original, but all of which together will constitute one and the same instrument. 6.0 Entire Agreement. This Agreement constitutes the entire agreement between the Parties with respect to the subject matter contained in this Agreement and H-SAA Amending Agreement extension to March 31, 2014 Page 1 188

121 supersedes all prior oral or written representations and agreements. IN WITNESS WHEREOF the Parties have executed this Agreement on the dates set out below. XXX LOCAL HEALTH INTEGRATION NETWORK By: [Name], Chair Date And by: [Name], CEO Date [Insert Full Legal Name of Hospital] By: [Name], Chair Date And by: [Name], CEO Date H-SAA Amending Agreement extension to March 31, 2014 Page 2 189

122 Resolution North East Local Health Integration Network (the Corporation ) Motion No.: 2013-BD0020 Moved by: Seconded by: Thursday, August 22, 2013 RESOLVED THAT: The NE LHIN Board of Directors approves the proposed H-SAA Amending Agreement, effective as the 1 st day of October 2013, which amends the 2008/13 H-SAA by extending its term to March 31, Elaine Pitcher Chair 190

123 Page 1 of 2 North East LHIN Briefing Note NORTH BAY REGIONAL HEALTH CENTRE FLS DESIGNATION August 22, 2013 Issue(s) The North Bay Regional Health Centre (NBRHC) is requesting partial designation under the French Language Services Act for over 40 front-line services including Communications (switchboard), Emergency, Occupational Therapy, Physiotherapy, mental health programs, and others. An FLS designation officially recognizes an agency/service as a provider of quality FLS. Their request requires NE LHIN Board approval before being submitted to the Ministry of Health and Long-Term Care for review. Background and Context In 2011, the NE LHIN identified the NBRHC as a candidate for FLS designation due to the hospital s status as a hub hospital, its district and regional mandates to serve areas where 21% of the population is French-speaking, and its existing human resource capacity to deliver services in French. For two years, the NBRHC worked diligently with the NE LHIN FLS Coordinator to identify units/departments that would be ready for an FLS designation, develop policies and strategies for the effective delivery of FLS, develop an FLS Designation Plan, roll-out its work plan to finalize the request for partial designation by March 31, 2013, and provide regular progress reports to the LHIN. On March 26, 2013, the NBRHC submitted its request for partial FLS designation to the LHIN. The FLS Designation Plan was reviewed by a committee comprised of LHIN staff and members of the FLS Planning Entity the Réseau du mieux-être francophone du Nord de l Ontario. The committee made recommendations to the NBRHC to improve the FLS Designation Plan, which were included in a final version submitted to the LHIN on July 30, The committee supports NBRHC s request for partial FLS designation. Current Status The plan is not included in the board package (due to its volume), but is available for review at the LHIN office. Financial Information N/A Key Messages This designation request is aligned with one of the NE LHIN s priorities in its Integrated Health Service Plan Target the Needs of Culturally Diverse Population Groups (Francophones). FLS designation is important for a hub hospital especially with a considerable Francophone population given the hospital s mandate to provide district and regional services. Two of the four other hub hospitals are already designated under the FLS Act Timmins & District Hospital and HSN. The Francophone community in Nipissing expects its district hospital to provide quality French language services. 191

124 Next Steps Once approved by the NE LHIN Board of Directors, the NBRHC FLS Designation Plan/request will be sent to the Office of French Language Services of the Ministry of Health and Long-Term Care for their review. The plan is then sent to the Office of Francophone Affairs for further review. The final step involves an amendment, through Cabinet, of the FLS Act to include NBRHC as a partially designated agency. NBRHC will continue to prepare its remaining units/departments to eventually request full designation under the FLS Act. Author(s) Lise Anne Boissonneault, Outreach Officer, Nipissing/Temiskaming Page 2 of 2 192

125 Resolution North East Local Health Integration Network (the Corporation ) Motion No.: 2013-BD0021 Moved by: Seconded by: Thursday, August 22, 2013 RESOLVED THAT: WHEREAS the NE LHIN Board supports the request for partial designation of French language health services under the French Language Services Act, submitted by the North Bay Regional Health Centre; THEREFORE the North East LHIN Board recommends its approval to the Office of French Language Services of the Ontario Ministry of Health and Long Term Care as agreed upon at its meeting of Thursday, August 22, Elaine Pitcher Chair 193

126 NORTH EAST LHIN BRIEFING NOTE WAHA Stage 1 Part A Capital Submission TO: NE LHIN CEO NE LHIN Board of Directors Other FROM/AUTHOR: Martha Auchinleck DATE: August 14, 2013 SUBJECT/PURPOSE: Letter of Support: Weeneebayko Area Health Authority (WAHA) Stage 1 Capital Submission RECOMMENDED ACTION: For Decision For Information Other (specify) Background and Context: The Weeneebayko Area Health Integration Framework Agreement (WAHIFA) (agreement between Canada, the Province of Ontario, five First Nation communities of Attawapiskat, Fort Albany, Kashechewan, Mocreebec Non profit Development Corporation, Weenusk and the Town of Moosonee), outlined the process WAHA would follow for redeveloping their facilities in the James and Hudson Bay Area. WAHIFA section 5 commits WAHA to develop a hospital infrastructure/facility development plan based on the Ministry of Health and Long Term Care Capital Planning process, and within that plan, to make improved facilities for Kashechewan a priority. WAHA operates thee hospital facilities (Weeneebayko General Hospital (WGH) on Moose Factory Island, Fort Albany Hospital and Attawapiskat Hospital, as well as one Health Centre in Moosonee). An engagement process was conducted in 2011/12 to better understand the needs of each community and a Pre Capital submission was developed in 2012, which identified the following capital priorities: o Replace the WGH hospital (64 years old) o Improvements to the Moosonee Health Centre o Development of a health facility in Kashechewan o Improvements to Attawapiskat, For Albany and Peawanuck facilities Under the Ministry Capital Planning Process, the Stage 1 proposal Part A, which the LHIN must review and give a letter of support, is intended to outline the present and future delivery service model, as well as high level options to implement this future model. The capital and operating implications are also identified. The NE LHIN and the Ministry of Health have met with WAHA and their consultants to review the Stage 1 proposals to provide comments and questions. WAHA has addressed the comments raised by the LHIN, which were mainly focused on clarifying the service delivery model. WAHA s model of care seeks to support and sustain the health of the local communities by providing the core health care services needed by residents along their lifespan, developed in a culturally respectful, health empowering way. They will also partner with other providers formally and informally to integrate and optimize services and resources. WAHA is proposing to improve services for midwifery, mental health and addictions, chronic disease management and treatment, consistent and coordinated primary care and increased elderly services. WGH will be the regional centre for WAHA and they will deliver secondary services consistent with its critical mass and isolation. This will include continued delivery of general surgical services with visiting specialist (OTN consultations) and accommodate new services such as detoxification beds, mental health observations beds, satellite oncology, elder care North East Local Health Integration Network Briefing Note 194

127 services that encompass a continuum of care and support, and a hostel space for expectant mothers from the coastal communities. Next Steps: Seek LHIN support for the Stage 1 Capital proposal Part A Seek Ministry approval for Stage 1 Part A. If approved, WAHA could proceed to Stage 1 Part B planning WAHA will continue to engage the communities to seek input into the development of the facilities. Coastal visit occurring August 22 to Aug 30 th. North East Local Health Integration Network Briefing Note 195

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