ce/guide%20to%20open%20meetings.pdf

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1 BRIEFING NOTE Toronto Central Local Health Integration Network Board of Directors Meeting February 25, 2015 Agenda Item 1 Welcome & Call to Order The Toronto Central Local Health Integration Network (TC LHIN) welcomes the public to its open Board meeting. Please refer to A Guide to Open Meetings of the Toronto Central Local Health Integration Network (LHIN). Agenda Item 2 Guide to Open Meetings of the Toronto Central Local Health Integration Network Link to guide: ce/guide%20to%20open%20meetings.pdf Agenda Item 3 Approval of Agenda Agenda Item 4 Declaration of Conflict(s) The Board member(s) shall at this time in the meeting declare any conflict(s) of interest in accordance with the LHIN Conflict of Interest Policy. Agenda Item 5 Voluntary Integration Community Resource Connections Toronto/Fred Victor Voluntary Integration TOPIC: Voluntary Integration of Community Resource Connections of Toronto and Fred Victor Centre PURPOSE OF THIS AGENDA ITEM To seek a Board motion not to stop the Community Resource Connections of Toronto and Fred Victor Centre voluntary integration from proceeding. BACKGROUND: On January 26, 2015 Community Resource Connections of Toronto and Fred Victor Centre gave formal notice to Toronto Central LHIN of the potential integration of the two organizations. The agencies proposed that Fred Victor Centre would assume all of Community Resource Connections of Toronto s services effective April 1, 2015 through a transfer of assets and liabilities from Community Resource Connections of Toronto to Fred Victor Centre. A letter of intent between the two organizations provides for the transfer of assets, liabilities, employees, funding agreements and operations. The agencies provided a signed Letter of Intent to Integrate TC LHIN Board of Directors Meeting, February 25,

2 and a business case that includes a community engagement plan. Upon receipt of a Notice of an Intent to Integrate services pursuant to s. 27 of the Local Health System Integration Act (LHSIA), the Toronto Central LHIN has 60 days to carry out its due diligence. This involves a review of the proposed integration by Toronto Central LHIN staff and provides a recommendation to the Toronto Central LHIN Board either to stop or to not stop the integration. The aspect of the merger for which the Toronto Central LHIN is responsible is the integration of services. As with all voluntary integrations, the Toronto Central LHIN is responsible for assessing whether the proposal is in the interest of patients and the population and in alignment with the Toronto Central LHIN s health system goals and priorities. Community Resource Connections of Toronto and Fred Victor Centre Background Community Resource Connections Toronto and Fred Victor Centre provide different but complementary services within Toronto Central LHIN. Both health service providers serve a marginalized and vulnerable population. Community Resource Connections of Toronto has a long history in the community mental health sector providing case management services to individuals living with mental health and addictions challenges. Fred Victor Centre also has a long history in the City of Toronto providing affordable supportive housing to the homeless and those living in poverty. The integration of Community Resource Connections of Toronto and Fred Victor Centre will increase access to case management services for individuals who are homeless and living with mental health issues. This integration will result in improved housing outcomes for individuals who are at risk, and will lead to better health and quality of life, thereby reducing avoidable hospital visits. Table 1 below provides a summary of services, service volumes, staffing and Toronto Central LHIN funding for each agency and the combined organization. Table 1: Community Resource Connections of Toronto and Fred Victor Centre Community Resource Connections of Toronto Fred Victor Centre Total Programs/Services Community mental health case management services provided in 8 locations throughout the City of Toronto. Also provides outreach to individuals in hostels and in the court system. Permanent and affordable housing and support services to the homeless. Also provides outreach to the homeless in dropin centres and shelters, as well as counselling and employment training Case management and housing with supports will be combined to provide a comprehensive basket of service for individuals who have mental illness challenges and are living in poverty or are homeless Population served Individuals with mental health and addictions challenges living in poverty Individuals who are homeless or living in poverty. Table 1: Community Resource Connections of Toronto and Fred Victor Centre Community Resource Fred Victor Centre Total Connections of Toronto Programs/Services Population served Community mental health case management services provided in 8 locations throughout the City of Toronto. Also provides outreach to individuals in hostels and in the court system. Individuals with mental Permanent and affordable housing and support services to the homeless. Also provides outreach to the homeless in drop-in centres and shelters, as well as counselling and employment training Individuals who are Case management and housing with supports will be combined to provide a comprehensive basket of service for individuals who have mental illness challenges and are living in poverty or are homeless TC LHIN Board of Directors Meeting, February 25,

3 health and addictions challenges living in poverty 2,688 individuals annually homeless or living in poverty. Clients 8,000 individuals 10,688 individual annually annually Staff LHIN Funding $5,558,694 $1,510,642 $7,69,336 (2014/15) Total Funding $6,118,985 $15,000,000 $21,118,985 (2014/15) (See Attachment A for a brief Organizational Profile of both health service providers.) Rationale for Voluntary Integration In June 2013 Community Resource Connections of Toronto began considering the possibility of a merger with a community partner to ensure the sustainability of client services into the future. This decision by the Community Resource Connections of Toronto Board of Directors was prompted by the combination of several factors including; the resignation of the Executive Director, recognition that the agency s administrative infrastructure was under-resourced relative to its size, and the emerging demands for increased accountability and evidence based practice. The Board of Community Resource Connections of Toronto determined that the best option for the organization to sustain service targets and quality over the long term was integration with another organization with a better developed administrative and management infrastructure. In July 2014, Community Resource Connections of Toronto announced their intention to partner with Fred Victor Centre in a voluntary integration, and both organizations began their internal due diligence process. This due diligence process has led to the completion of a detailed business case with a target date for integration of April 1, TORONTO CENTRAL LHIN S REVIEW PROCESS The Toronto Central LHIN is emphasizing three areas of focus viewed as being most critical to the success of the Community Resource Connections of Toronto and Fred Victor voluntary integration: 1) Quality; 2) Access; and, 3) Efficiency. With this focus, the Toronto Central LHIN staff analyzed the proposed integration of services using the following criteria from the LHIN Decision Making Criteria for Voluntary Integration Checklist: Access / Equity / Coordination; Community Engagement; Quality / Health Status / Clinical Outcomes; and, Efficiency / Sustainability/Human Resources. (See Attachment B for a detailed description of the LHIN Decision Making Criteria for Voluntary Integration Checklist.) The following describes the Toronto Central LHIN s analysis of the Community Resource Connections Toronto and Fred Victor Centre business case for voluntary integration. BUSINESS CASE REVIEW Access/Equity/Coordination Business Case Rationale The combined organization of Community Resource Connections of Toronto and Fred Victor Centre will continue to serve people in the City of Toronto who live in poverty, or are homeless, or at risk of becoming TC LHIN Board of Directors Meeting, February 25,

4 homeless, who are marginalized and vulnerable, and live with mental health and addictions issues. The integrated organization will continue to serve this population through a more comprehensive and integrated basket of supportive housing and case management services. The integrated organization will also increase the number of clients receiving case management and housing support services. The value proposition of the integration of both organizations includes: More comprehensive knowledge of client needs. Expanded basket of services. Increased access to needed services. Improved health and housing outcomes. Increase evaluation and research capacity. The voluntary integration of Community Resource Connections of Toronto and Fred Victor Centre will have a positive impact on the populations served by both organizations. The findings of the Health Equity Impact Assessment indicate that the integrated organization will not only continue services to their current populations, but also increase access for clients to skilled staff and specialized programs. The Health Equity Impact Assessment indicated that there were no negative impacts anticipated through this integration. The integrated organization has committed to ongoing monitoring of client satisfaction of each of the population groups served. TC LHIN Assessment The Toronto Central LHIN s primary concern is that service levels to the population currently being served, are enhanced. We believe the business case provides reasonable assumptions and a plan for maintaining specialized programs and increasing access to case management services to clients within the combined existing budget of the new organization. We are confident through our review of the business case that the two boards and integration team have given sufficient consideration to addressing the needs of their clients and are committed to maintaining and improving access to and coordination of services, and that all potential impacts to vulnerable populations have been addressed. The Toronto Central LHIN will assess any changes in access to services as part of our post-integration evaluation process every six months for the next two years. Community Engagement Business Case Rationale Community Resource Connections of Toronto and Fred Victor Centre developed a communications and community engagement plan designed to engage key stakeholder groups including: clients, broader community, staff both front line and management, Board members, Unions, partner organizations in the community mental health and addictions sector, funders, volunteers, and donors. These stakeholders were engaged in a variety of different ways recognizing that stakeholders have different interests, concerns and communication needs. Techniques include meetings both in town hall and focus groups, letters, website notices and e-bulletins, discussions and conversations either individual, group, or by telephone. Communication of key messages and managing questions and answers were delivered in a variety of combinations by Board members and management staff from both organizations. For example, a focused conversation between staff from Community Resource Connections of Toronto and the Executive Director from Fred Victor Centre occurred specifically about transition. Similar conversations of both general and focused nature occurred throughout the engagement phase. Throughout the engagement, common themes emerged from the consultations. The key issues and responses provided are as follows: Clients will continue to have access to the same programs and staff - All communication has reinforced the message that client/staff relationships and program/service continuity will be maintained. Clients did not TC LHIN Board of Directors Meeting, February 25,

5 have an affiliation for the Community Resource Connections of Toronto name or branding, but have a very strong affinity with the program and staff with which they are connected. Service improvement opportunities will be identified and initiated. Suggestions for improvements to access to services were identified by clients and sector partners throughout the engagement process. The response reinforced the commitment to service planning for increased access to service, and initiating immediate service improvements where possible. Engagement plans will also include consultations with staff and clients at six and 12 months post integration to measure satisfaction and identify opportunities for quality improvement. TC LHIN Assessment The agencies community engagement plan addresses the criteria set out in the Toronto Central LHIN s Health Service Provider Community Engagement Plan Checklist. The organizations are using targeted and appropriate activities to inform, consult and work with stakeholders through the planning stages of integration. There is evidence that the two organizations received feedback and provided appropriate responses. Quality / health status / clinical outcomes Business Case Rationale The voluntary integration will produce a number of benefits related to quality of services and health outcomes. Overall there will be greater organizational capacity and a more robust infrastructure to support performance measurement, evidenced based care and continuous quality improvement. The following table provides key performance indicators and outcome measures for the integration. Table 2: Performance Indicators for Integration Integration Objective Baseline Indicator Target Improve access to mental health case management services, and housing support services. Case Management 908 clients Baseline for Baseline for Housing Support Case Management 750 clients health case management service. Target of 40 new clients referred to mental Target of 40 new clients referred to Housing Support Case Management. High risk clients have a case manager assigned within 24 hours of assessment. Baseline for high risk clients for integrated organization will be determined. Target of 15 new high risk clients will be identified and assigned to case managers. Learning and knowledge transfer strategy established. Staff practices reflect knowledge of health equity goals and cultural competencies in service delivery. New process for staff education and knowledge transfer and tracking to be developed. New Learning and knowledge transfer strategy to be launched in Targets to be established at that time. Program staffs receive training and education on care coordination tools. All staff. 100% of staff will receive training by end of 2015/16. TC LHIN Assessment Upon review of the business case and from conversations with Community Resource Connections of Toronto and Fred Victor Centre, it is clear that planning is focused on building improved sustainability of the case management services provided by Community Resource Connections of Toronto. It is also clear that the organizations have identified opportunities to integrate their services to build more comprehensive service TC LHIN Board of Directors Meeting, February 25,

6 bundles for clients. This is evident with their goal of increasing and enhancing the internal referral of clients to staff with expertise in mental health case management and those with expertise in housing support services. The result is a more robust basket of service available to clients more quickly. Efficiency/Sustainability The voluntary integration between Community Resource Connections of Toronto and Fred Victor Centre will result in improved administrative functions, enhanced accountability and increased capacity to monitor organizational performance. Community Resource Connections of Toronto has a small administrative infrastructure and Fred Victor has some capacity to assume these functions without significant increases to ongoing costs after the integration is complete. The potential annual savings will be realized through the reduction of salary and benefit costs for the Executive Director position; fees for professional, audit and accounting services; and communication costs for the website, annual report and Board costs for Community Resources Connections of Toronto. Investments are planned for a new Clinical Services Director position that will be related to the service improvements outlined in Table 2. Additional costs include one-time investments in human resource systems, Information Management and Information Technology systems, and service quality improvement tools. The total projected ongoing savings from this voluntary integration is estimated to be $163,000 annually. The ongoing expense will be potentially $100,000 for staffing. The business case also includes an estimated $80,000 in one-time costs to merge systems such as accounting, information management, human resources, and communications. The ongoing and one-time costs will be incurred over the post integration period over the next two years, and offset with the estimated savings. Once the one-time expenses are covered, all savings will be invested to support ongoing service costs. The integrated organization will have a balanced budget and no additional Toronto Central LHIN funding will be required to support the ongoing operations post integration. The business case included a comprehensive risk assessment identifying sixteen potential risks arising from the integration. Examples of the potential risks include disruption of service, loss of confidence of the integrated organization by clients, failure to create a cohesive organization, and failure to successfully transfer current leases to Fred Victor Centre. All of the risks identified have satisfactory mitigation responses and all were assessed as being of low probability with medium to high impact. It is evident from the risk assessment and other components of the business case that careful consideration has been given to potential risks, even those of low probability. Community Resource Connections of Toronto and Fred Victor Centre are unionized environments. The business case outlines a human resources plan based on principles that will support a smooth transition of bargaining and non-bargaining unit staff from Community Resource Connections of Toronto to Fred Victor Centre recognizing rights based on collective agreements, employment law and common law. The principles of the human resources plan include: Fred Victor Centre will become the employer. Fred Victor Centre will provide comparable employment to all who are employees of Community Resources Connections of Toronto on April 1, Community Resources Connection of Toronto staff will carry forward all accrued entitlements. Terms of collective agreements with SEIU and OPSEU will be continued. Human resource practices will be harmonized over time in accordance with collective agreements. A working team made up of staff from both organizations will plan the integration of human resources practices. TC LHIN Assessment The business case provides sufficient evidence that this voluntary integration will result in the sustainability of the organization and that services will be maintained with select services expanded over time. In addition, it is expected that service quality will be enhanced through the leveraging of expertise and strengths from both TC LHIN Board of Directors Meeting, February 25,

7 organizations. They have considered potential risks associated with integration and developed strategies for mitigating those risks. NEXT STEPS Subject to the voluntary integration proceeding, the Toronto Central LHIN will work closely with the merged organization from the initiation of the voluntary integration in April, 2015 through to when Community Resource Connections of Toronto affairs have been wound down. Toronto Central LHIN will work with the agencies regarding the transfer of funding from Community Resource Connections of Toronto to Fred Victor Centre. Fred Victor will participate in a comprehensive post integration reporting process with the Toronto Central LHIN. The agency will be required to provide progress reports to Toronto Central LHIN, which will track the system impacts and progress on the voluntary integration over time. Progress reports will be required at 6, 12, 18 and 24 months and include progress on the service levels compared to baseline; savings/efficiencies and reinvestment; quality improvement and update on any other issues including human resources and feedback from follow up community engagement. MOTION: The Toronto Central LHIN Board will not stop the voluntary integration between Community Resource Connections Toronto and Fred Victor Centre from proceeding. ATTACHMENT A - ORGANIZATIONAL PROFILES Community Resource Connections of Toronto Community Resource Connections of Toronto is a non-for-profit, charitable organization since 1974 serving people in the City of Toronto with mental health and addictions challenges living in poverty. It has a history of developing and partnering in new initiatives. The mission of the organization is to support people affected by serious mental illness to achieve fulfilling lives in their communities through services, partnerships and promoting the right to self-determination. Service include: Community Support Services Supports for daily living provided to people with serious mental health issues. Services are provided in English, Tamil, Somali and other languages across the City of Toronto. Diverse populations from seniors to children and youth receive the community services. COPE Culturally appropriate case management services for people experiencing first episode psychosis. Services provided in English, Cantonese, Mandarin and Tamil. Hostel Outreach Program and Street Outreach Services for Women Long term mental health supports for homeless men and women using the shelter system and street outreach services to women who are sleeping rough. Mental Health Court Support Services Services to assist people who are appropriate for diversion from the criminal justice system. A mental health court worker develops a plan in conjunction with the client and the Crown Attorney. Mental Health Court Housing Support Services to help people who are homeless and being released from police custody to access and maintain stable housing Health Promotion - Groups, social recreation, advocacy and resources to build sector mental health service capacity TC LHIN Board of Directors Meeting, February 25,

8 STOP Program St. Jamestown outreach to older adults in Toronto Community Housing buildings to support them to remain independent and to retain their housing. Fred Victor Centre Fred Victor Centre is a charitable, not-for-profit organization serving people in the City of Toronto for over 120 years. The organization provides responsive, accessible and innovative housing and support services for people who are experiencing homelessness and poverty. Fred Victor Centre also provides: Community Programs - New and second-use clothing items were given out at our Open House Drop-in Program to people trying to meet their basic needs. The Women s Day Program provides workshops focused on health, legal and social services for seniors. Health Services - Individuals with histories of addiction and mental health challenges receive counselling, practical assistance and specialized health services through the Concurrent Disorder Support Services and Mental Health and Justice Programs. Employment and Training - Job-search workshops and skills development programs are provided to clients. One workshop is specifically targeted to meet the needs of the Trans community. Hiring people with lived experience of homelessness Fred Victor Centre provides training and employment opportunity to clients through Fred Victor s Friends Catering. Permanent Affordable Housing - 96 tenants were stably housed at Fred Victor s 145 Queen Street East affordable housing last year. There were no evictions and no tenants abandoned their units. 80 affordable apartment units on Mortimer Road and on Dawes Road are home to families. There are 60 children. Three units provide six spaces for Crown Wards to begin their adult life. 139 men and women experiencing mental instability and/or addictions, or physical disabilities were successfully supported in active living and stable housing by Fred Victor support workers. Emergency Shelters people in the Fred Victor shelters moved on to improved living circumstances after receiving housing help from housing access workers at Fred Victor Bethlehem United Shelter on Caledonia Road and our Women s Hostel downtown. Housing Access Support Services individuals and families moved to affordable housing from street. ATTACHMENT B - DECISION MAKING CRITERIA FOR VOLUNTARY INTEGRATION CHECKLIST Goal Criteria - Specifics for Community Resource Connections and Fred Victor Centre Integration Access/Equity /Coordination Articulation of current services and volumes provided by health service provider and plan to maintain or improve. Agreement that service levels for current services provided be maintained and that target services be increased as a result of new capacity created by the voluntary integration. Agreement that partnerships with current health service providers will be honoured, enhanced, monitored, and reported. Community Engagement Engagement plan reflects best practices and follows LHINs Health Service Provider Community Engagement Plan Checklist. Process for providing quarterly progress reports to Toronto Central LHIN on how community feedback was considered and addressed. TC LHIN Board of Directors Meeting, February 25,

9 Letters of support from key stakeholders received regarding proposed plan. Quality Health Status/Clinical Outcomes Sufficient detail to articulate how the proposed integration will achieve enhanced quality and equity of services for patients and related monitoring and reporting framework. Efficiency/ Sustainability /Human Resources No additional operating funds required from Toronto Central LHIN during or after integration. The provision of an estimated summary of savings and commitment to reinvest savings in front-line services. Balanced budget forecasted for new organization. Leadership and governance model is reasonable and endorsed by both organizations and Toronto Central LHIN. Risk assessment is thorough and identified risks have practical mitigations proposed. Agreement to provide the Toronto Central LHIN with reports on organizational due diligence with respect to finances and legal matters (asset transfers, incorporation etc.) from April 2015 through to when Community Resource Connections affairs are have been wound down. Agreement to submit post integration progress reports to Toronto Central LHIN for the continued monitoring and evaluation of the voluntary integration. Evidence that there is an HR and labour relations plan that is being followed and implications have been identified and are being addressed. Agenda Item 6 Integration Report TOPIC: Report on Voluntary Integrations in Toronto Central LHIN PURPOSE OF THIS AGENDA ITEM To provide the Board of Directors with an overview of voluntary integrations in Toronto Central LHIN. Specifically this briefing note will: Describe the integrations that have occurred, Describe the approach and process of managing integrations, and Outline areas for managing integrations going forward. Background Local Health Integration Networks (LHINs) are governed by the Local Health System Integration Act (LHSIA). Part 5 of LHSIA refers specifically to integrations. To date, Toronto Central LHIN has taken the position of encouraging Voluntary Integrations between any health service providers that choose to pursue integrations with one another. Voluntary integration begins with health service providers deciding to merge their services. Other LHINs have taken a similar approach to integrations, but some have also moved to facilitate integrations between health service providers. This is described later in this document. Toronto Central LHIN s position is one of encouraging and supporting the voluntary integration among health service providers, and has developed Voluntary Integration Pathways (the Pathways). Separate Voluntary Integration Pathways have been developed for community and hospital health service providers. The Pathways describe the LHIN s role and the steps in the voluntary integration process. This note will describe the results of voluntary integrations to date, and outline areas for improvement in managing integrations into the future. TC LHIN Board of Directors Meeting, February 25,

10 The role of Toronto Central LHIN in voluntary integrations is one of oversight to ensure that business cases presented by health service providers pursuing voluntary integration are compelling, comprehensive, meet the legislative requirements, and are consistent with the LHIN s Strategic Plan. Major components of the business case include community engagement, Health Equity Impact Assessment (HEIA), and a list of risks and risk mitigation strategies. The Voluntary Integration Pathways have developed from experiences gleaned from each successive voluntary integration activity in the community and hospital sectors. A key part of the Pathways, on a goforward basis, is ensuring there is an opportunity for a regular review to improve the process based on lessons learned. This continuous quality improvement activity provides clarity regarding Toronto Central LHIN s role and responsibilities in voluntary integrations and benefits future voluntary integrations through valuable feedback. This document will also provide a summary of the results of voluntary integrations since development of the pathways was started in 2011/12. Integrations, or mergers, among health service providers have been occurring since the inception of LHINs. A listing of all those mergers is provided, but the deliberate focus on and tracking of performance and impact of integrations did not start until 2011/12. Principles of Voluntary Integration: Toronto Central Health LHIN has, to date, taken a very clear and deliberate stance on integrations. The Toronto Central LHIN stance is one of enthusiastically encouraging, supporting, and assisting health service providers that voluntarily decide that integration is in the best interest of their clients and patients. Health service providers come to that decision for a variety of reasons. These may include: change in leadership at the senior management or governance level, financial pressures with no clear viable solution, lack of sustainability of services, and potential for service growth within a larger organizational structure. In all voluntary integrations, Toronto Central LHIN takes the responsibility for assessing whether the proposal is in the best interest of clients, patients, and the general populations served; as well as its alignment with the Toronto Central LHIN s health system strategic priorities. In this regard, Toronto Central LHIN focuses on the impact of the integration on patient populations, as well as the broader health care system including other health service provider. The overall goal for voluntary integrations is to achieve better outcomes for patients and clients, strengthen health care service quality, and achieve positive system impacts. These outcomes are defined as: Improved access to services, Enhanced capacity of services, Better client / patient experience, Stabilization of existing services, Improved quality of service, Improve transitions across the health care system, and Extend reach outside health care In every voluntary integration activity, health service providers are required to identify specific targets that are used to measure the success of the integration. Care is taken to align these targets to one or several of the goals listed above. The focus of the Toronto Central LHIN s review of a voluntary integration is not on the health service provider organizations in and of themselves. Although, voluntary integrations have typically resulted in mergers of organizations as the method to affect change in the way services are organized and delivered; integration is considered the means to the end. Integration is a methodology for affecting that change. TC LHIN Board of Directors Meeting, February 25,

11 Voluntary Integration Pathways The Toronto Central LHIN Voluntary Integration Pathways have been designed for community and hospital health service providers. The milestones described below are generic and common to both. While the details and intensity of each step will differ with the specific circumstances of each voluntary integration activity, the principles remain constant. The key milestones are: a) Initiation In this initial phase, health service providers meet several times to conduct preliminary work necessary to reach a joint decision to integrate. Toronto Central LHIN participation is at the call of the health service providers. This phase is typically not public, but the health service providers have progressed to the point, at a governance and senior management level, where they have agreed that an integration of services is in their best interest. In this initial stage, Toronto Central LHIN outlines the goals and priorities of voluntary integration from a LHIN perspective, as well as the Toronto Central LHIN review process and legislative requirements under LHSIA. Toronto Central LHIN provides resources and outlines the lessons learned and potential risks of integration from previous voluntary integrations. b) Announcement This phase consists of a joint public announcement by the heath service providers of their intention to pursue a voluntary integration. A public announcement does not serve as the formal notice to the Toronto Central LHIN of the health service providers intention to integrate. The formal notice to the LHIN is provided later with a business case containing the details of the integration. Toronto Central LHIN will consider one-time funding for community health service providers to assist with the costs associated with voluntary integration, specifically, project management and legal counsel. Hospitals are not offered this one-time funding. Hospitals typically have the corporate resources to manage additional onetime integration costs within their operating budgets. Toronto Central LHIN will also provide health service providers with an outline of the Toronto Central LHIN review process and legislative requirements under the Local Health System Integration Act. This involves a review of the proposed integration business case and provision of a recommendation to the Toronto Central LHIN Board either to stop or not to stop the integration, all within 60 days of receiving formal notice of intent to integrate. c) Business Case Review / Due Diligence Framework Once the Toronto Central LHIN receives a business case, it is reviewed by a Toronto Central LHIN Integration Team. In reviewing a business case for a voluntary integration, Toronto Central LHIN will apply a due diligence framework to measure the integration activity against predefined criteria aligned with the outcomes described under the Principles of Voluntary Integration above. (See Attachments A and B for further details on the criteria.) For Hospital integrations, Toronto Central LHIN will also provide a copy of the business case to the Ministry of Health and Long Term Care. The Ministry completes a concurrent review of the hospital business case. Formal voluntary integration business cases and letters of Intent to integrate are posted on the Toronto Central LHIN website for public comment on the proposed integration. Public comments are considered part of the community engagement process. The role of Toronto Central LHIN is not to respond directly on the public commentary, but rather to require the health service providers respond, and if necessary amend their business TC LHIN Board of Directors Meeting, February 25,

12 case accordingly. Business cases for voluntary integrations are not approved by Toronto Central LHIN either at the staff or governance level. Business cases are received and a staff report is prepared on the business case for the Toronto Central LHIN Board of Directors. Prior to receiving the formal business case for voluntary integration, Toronto Central LHIN staff will review early drafts of business cases and provide commentary and feedback to the health service providers. The purpose of this iterative process is to help ensure the final document is complete and comprehensive when formally submitted to Toronto Central LHIN. d) Toronto Central LHIN Board of Directors Toronto Central LHIN staff prepare a report for the Toronto Central LHIN Board outlining the analysis of the key components of the business case, and a recommendation to either stop, or not stop the integration from proceeding. A copy of the voluntary integration business case is not included with the staff report to the Board. The report is presented at a Toronto Central LHIN Board of Directors meeting within 60 days after receiving the formal Letter of Intent to Integrate. Health service providers may be requested to present their voluntary integration to the Toronto Central LHIN Board of Directors. Once the Toronto Central LHIN Board passes a motion on the proposed integration, anyone may make a written submission to the LHIN within 30 days of the Board decision. If a written submission is received, the LHIN has a further 30 days to consider the submission, and may either change or confirm the initial proposed integration decision. The LHIN will then issue a final decision. These steps are contained in the Local Health System Integration Act. e) Post Integration Engagement, Performance Monitoring and Evaluation All integrating health service providers are required to submit post integration progress reports measuring progress towards the targets identified in the business case. Reports are required at 6, 12, 18 and 24 months, or longer if necessary, following the integration date. Health service providers are expected to outline their ongoing engagement with stakeholders throughout the post integration phase. Health service providers do not receive additional base funding to cover any ongoing costs incurred as a result of the voluntary integration. Health service providers are expected to manage these ongoing costs within their current operating budgets. f) Internal Toronto Central LHIN Continuous Improvement Cycle All voluntary integrations are reviewed annually in a combined report. The combined voluntary integration report outlines the performance of the integrating health service providers against their performance targets, as well as look for opportunities for process improvements for the voluntary integration process. Debriefing meetings are held with all integrating health service providers to better understand what worked well and what should have been done differently. These lessons learned are built into the integration pathways, and shared with subsequent integrating health service providers. Integrating health service providers are asked to be available to mentor health service providers considering integration in the future. g) Non Voluntary Integration Pathway Activities Partnerships and Collaboration Some health service providers will, at the Initial Phase, engage the LHIN in a discussion on how they can partner or work more closely together without a change in how their services are organized. This is not a voluntary integration that triggers the Voluntary Integration Pathways. However, the LHIN does encourage these organizations to continue to partner and work more closely together. TC LHIN Board of Directors Meeting, February 25,

13 Funding Transfer In this scenario, a health service provider informs the Toronto Central LHIN that it intends to cease to provide a service(s) and that another health service provider is available and willing to assume providing the service(s). In this situation, Toronto Central LHIN transfers the required funding from one health service provider to the other. This is not a voluntary integration because there is no bringing of services together, but rather service delivery ends with one and begins with another health service provider. Toronto Central LHIN reviews the circumstances of the health service provider intending to end service provision and the appropriateness of the health service provider assuming the service. When this review is completed, funding is transferred. Since a funding transfer is an administrative activity, a Board decision is not required. Staff regularly report to the Board when funding transfer occurs. Voluntary Integrations in Toronto Central LHIN In Review Health Service providers in Toronto Central LHIN have been merging since 2008/09. The early mergers were characterized as small organizations closing and the service funding transferring to other health service providers. The first voluntary integration was in 2010/11 when York Community Services and New Heights Community Health Centre decided to merge and form a new entity, Unison Health Centre. Toronto Central LHN at that time began the development of the criteria framework to review integrations, as well as further refine our expectations of community engagement for health service providers. It wasn t until 2011/12 when two substantially large community organizations, Community Care East York and WoodGreen Community Services announced their integration, that Toronto Central LHIN started, in earnest, to develop a formal integration pathway. This was the first voluntary integration where Toronto Central LHIN provided one-time funding to help cover integration costs, as well as the first integration where post integration reporting expectations where developed. That same year, Toronto Rehabilitation Institute and University Health Network entered into a voluntary integration. That led to the start of the development of the hospital integration pathway. Since 2011/12 several community and hospital integrations have occurred resulting in successive refinements to the integration pathways for both community and hospital health service providers. The next step in the evolution of the Toronto Central LHIN existing integration pathways is to merge the two into one generic voluntary integration pathway. TC LHIN Board of Directors Meeting, February 25,

14 Summary of Integrations Year Health Service Providers Integration Type 2008/09 Meals on Wheels East Toronto and WoodGreen Community Services Jack McCreadie Towers and WoodGreen Community Services 2009/10 TECS Community Housing and Support Services with WoodGreen Community Services Homeward Mental Health Services and COTA Health My Brothers Place and Regeneration House 2010/11 York Community Services and New Heights Community Health Centre formed Unison Health Centre Funding Transfer Funding Transfer Funding Transfer Funding Transfer Funding Transfer Voluntary Integration 2011/12 Community Care East York and WoodGreen Community Services Toronto Rehabilitation Institute and University Health Network Voluntary Integration Voluntary Integration 2013/14 Mid-Toronto Community Services and Dixon Hall Neighbourhood Services St. Johns Rehabilitation Hospital and Sunnybrook Health Sciences 2014/15 ABI Possibilities and PACE Independent Living Three Trilliums Community Services and The Canadian Red Cross Society Friends and Advocates and Sound Times True Davidson Meals on Wheels and Neighbourhood Link Neighbourhood Link with Central Neighbourhood House Community Outreach Program in Addictions (COPA) and Reconnect Mental Health Services Bridgepoint Health and Mount Sinai Hospital Community Resource Connections Toronto and Fred Victor Centre Voluntary Integration Voluntary Integration Voluntary Integration Voluntary Integration Funding Transfer Voluntary Integration Voluntary Integration Voluntary Integration Voluntary Integration Voluntary Integration The impact of voluntary integrations can be seen in three areas, the client / patient, service quality, and the broader health care system. Integrations have the most direct impact on the client / patient as exemplified through increased volumes of service, enhanced access to services, and improved client satisfaction with services. All the voluntary integrations we have seen in Toronto Central LHIN since 2011/12 have identified specific integration performance objectives in volume increases, increased number of clients served, and or improved client satisfaction measured by the health service provider s own tools. The second area of impact is the improvement in the quality of the service or the way services are provided. TC LHIN Board of Directors Meeting, February 25,

15 Health service providers have committed to invest time and resource to develop knowledge centres where current practices in service delivery can be improved through research, enhanced staff and volunteer training and education. The third area of impact is at the broader health care system level. Health service providers have begun to identify impacts they can have on other health service providers in other sectors. This is a conscious alignment of integration effort and results to the Toronto Central LHIN strategic plan. For example, recent community health service provider voluntary integrations have identified a reduction in emergency department visits by their clients as a goal for their integration. All voluntary integrations, from the latter half of 2014/15 going forward, are asked to identify, wherever appropriate, performance objectives and targets in all three areas: direct client and patient services, quality of services, and systemic impact. These are the three key and deliberate areas of voluntary integration impact. Integrations have an untapped potential to also reach outside the health care system. Toronto Central LHIN has established more formal dialogue with the City of Toronto and the United Way to determine the potential impact of integrations reaching populations served in the social welfare systems. Toronto Central LHIN has also reached out to sister LHINs in the Greater Toronto Area to explore opportunities for the virtual integration of services at a regional level. More work is needed in both these areas to understand the expanded potential of voluntary integrations. Expected Results from Recent Voluntary Integrations Since 2011/12, Toronto Central LHIN has started to track health service provider performance on voluntary integration objectives. The timeline for voluntary integrations to reach their targets is typically 24 months. The Community Care East York and WoodGreen Community Services voluntary integration was the first to reach their 2-year timeline with overall success in meeting their initial stated targets. All other integrations are currently operating within their post integration period. Toronto Central LHIN continues to monitor progress every 6 months. Toronto Central LHIN provides one-time funding to help cover integration costs for community health service providers. Eligible expenses have been targeted specifically for project management, due diligence, and legal counsel. Funding is one-time only in nature to cover these added costs of preparing a business case for integration. Toronto Central LHIN has recognized that community health service providers do not have the infrastructure to invest time and resources on integration activity while trying to maintain direct service delivery to clients. The total one-time funding provided to date by Toronto Central LHIN to assist with these one-time costs is $1,411,985. All the completed voluntary integrations to-date has produced process efficiencies within the integrated organizations resulting in savings in ongoing operating costs. The projected savings in the community integrations are $1,035,973, and for hospital integrations are $8,800,000. All these projected savings are being reinvested in services for clients and patients on a perpetual basis. The key is that with the Toronto Central LHIN investment of one-time funding, clients and patients receive an ongoing benefit through enhanced services year after year. The charts below illustrate the range of achieved and expected improvements and enhancements. All of these improvements are expected without the need for additional ongoing base funding from Toronto Central LHIN. These expected results are our indicators of success of the voluntary integrations. The chart contains a selection of the objectives for each voluntary integration activity. The individual business case for each integration activity contains a complete list of the objectives. Toronto Central LHIN has and will continue to take the clear position that voluntary integrations are not a costrecovery exercise. While cost savings are expected from improved efficiency, these savings are required to be re-invested by the health service providers into client and patient services. Toronto Central LHIN will continue to monitor the results of all integrations to measure the success of each. TC LHIN Board of Directors Meeting, February 25,

16 Community Voluntary Integration Results Health Service Providers Integration Objectives Target Investment Timeline Community Care East York and WoodGreen Community Services Increase Service Volumes: Case Management Social Recreational Programs Social and Congregate Dining Adult Day Program Volunteer Services Creation of a Voluntary Integration Tool Kit 10% to 30% increase in volumes. Tool Kit broadly distributed. $315,000 January 2014 All service volumes exceed target with exception of Congregate Dining Tool Kit widely used Mid-Toronto Community Services and Dixon Hall Increased Service Volumes: Elderly Persons Centre Adult Day Programs Harm Reduction Program Housing Case Management Legal Clinic Services Outings for Seniors and Youth Intake and Coordinated Services 9.5% increase overall in volumes $118,000 January 2016 ABI Possibilities and PACE Independent Living * Increased Service Volumes: Day Program Services Psychology Services 30% increase in volumes $24,000 June 2016 True Davidson Meals on Wheels and Neighbourhood Link Increased Service Volumes: Meals on Wheels 4% increase in volumes $20,973 May 2016 Neighbourhood Link and Central Neighbourhood House Increased Service Volumes: Congregate Dining Respite Services Crisis Intervention Conversation Circles Meals on Wheels 6% to 20% increase in volumes $140,000 July 2016 Creation of Knowledge Centre for above services. Three Trilliums and Red Cross Society Improve Client Satisfaction Rate Develop volunteer opportunities through innovative practices. 5% increase Additional 40 volunteers $105,000 June 2016 Strengthen Independent Living philosophy throughout Red Cross Ongoing Community Outreach Program in Increase Case Management volumes 5% increase in volumes $150,000 October 2016 TC LHIN Board of Directors Meeting, February 25,

17 Addiction (COPA) and Reconnect Mental Health Services Improve Client Satisfaction rates Reduce number of avoidable client hospitalizations New Quality of Life tool. 5% reduction in hospital visits Community Resource Connections and Fred Victor Centre Increase Service Volume for Case Management. Increase number of clients with combined case management and housing support services 20% increase in volume 30% increase in volume $163,000 April 2017 Set target for high risk clients receiving case management within 24 hours of assessment. 100% of high risk clients. Sub Total Overall improvement ranging from 4% to 30% expansion of service volumes, improved client satisfaction, improved quality of services, and reduced avoidable client hospitalization. $1,035,973 Hospital Voluntary Integration Results Health Service Providers Toronto Rehabilitation Institute and University Health Network Integration Objectives Target Investment Timeline Increased inpatient referrals to rehabilitation and complex continuing care beds. New initiatives in stroke and Neuro rehabilitation care 13% to 22% increase in referrals $5,000,000 June 2013 St. Johns Rehabilitation Hospital * and Sunnybrook Health Sciences Research and Education Sustainability of rehabilitation services at the St. John s site. Improved rehabilitation practices and stroke care Research and Education Overall stabilization of rehabilitation services. $2,300,000 July 2014 Bridgepoint Health and Mount Sinai To Be Determined by April 2015 To Be Determined $1,500,000 November 2016 Sub Total Overall improvement of inpatient rehabilitation services. NOTE: * Central LHIN health service provider $8,800,000 Not All Integrations are Successful While most activity that was started in Toronto Central LHIN resulted in a successful integration, some did not. The lesson learned from the integrations that did not proceed highlighted the need for all levels of the organizations to have a common understanding and agreement to the integration. One example of an integration that did not proceed illustrated that the staff and senior management shared a common understanding of the integration, but the Governors of each organization did not. TC LHIN Board of Directors Meeting, February 25,

18 The lesson learned in this example is, the need for frank and repeated discussion of the goals of integration early on and throughout the integration process, at the Governance and staff levels. Experience from Other LHINs Several other LHINs have experience with integrations which will benefit Toronto Central LHIN as we consider future activity in this area. Toronto Central LHIN staff reviewed summaries from integration activity from six other LHINs: Hamilton Niagara Haldimand Brant, Central East, Waterloo Wellington, South West, South East, and North East. These LHINs reported on a combination of over fifty integrations. All LHINs described very similar approaches to voluntary integrations compared to Toronto Central LHIN. Some described similar instances where services where transferred, and entire health service provider organizations merged. The key message that surfaced consistently was that a planned and extensive community engagement effort is very important to the success of the integration. This is the same conclusion we in Toronto Central LHIN have reached. Some LHINs have also facilitated integrations where health service providers where brought together by the LHIN with the aim of integrating or merging their services. Central East and South East LHINs appear to have the greatest experience with facilitating integrations. The key elements to success in facilitated integrations from these two LHINs are: Build a positive relationship between the Health Service Providers, Ensure Health Service Providers, at all levels, understand the need for change, Maintain a focus on improving client and patient outcomes, Engage the community, Provide enough time for the integration to develop. To date, Toronto Central LHIN has not facilitated integrations, but this experience from other LHINs is valuable information for consideration of integration options for the future. Integrations A View to the Future Toronto Central LHIN integration activity must continue to be viewed from multiple perspectives: the impact on clients and patients, impact on quality of services, and broader systemic improvements. This is the foundation upon which integration activity is based in this LHIN. Success to date in integrations is directly related to the Toronto Central LHIN s stance of supporting voluntary integrations. Toronto Central LHIN has and will continue to foster a positive environment for health service providers to pursue voluntary integrations. The success to date with voluntary integration in Toronto Central LHIN is directly related to several contributing factors: Voluntary integrations are championed and driven by health service providers, Voluntary integrations receive clear and concrete support through targeted one-time funding, when appropriate, and Toronto Central LHIN staff support throughout the integration process, and Voluntary integrations continue to be positioned by the Toronto Central LHIN Board as a strategic option for health service provider Governors to chart their own destination for growth and sustainability independent from a reliance on funding increases. Toronto Central LHIN will also continue to require health service providers to invest any savings from integration activity into client and patient care. Integration activity is not a cost recovery exercise, but it is a proven method to identify and realign resources to client services, as they become available. TC LHIN Board of Directors Meeting, February 25,

19 Toronto Central LHIN will continue to enthusiastically support voluntary integrations at all levels throughout the organization. Staff will continue to support health service providers through the integration process. Toronto Central LHIN Board of Directors will continue to advance the strategic advantages of integration among Governors of health service providers at Board to Board engagement sessions. In short, Toronto Central LHIN will continue to pursue voluntary integrations with all those heath service providers who are ready. The challenge before this LHIN is how to sustain the success experienced to date with voluntary integrations, while moving to targeted or strategic integrations facilitated by Toronto Central LHIN. The Local Health System Integration Act states in section 24 that: Each local health integration network and each health service provider shall separately and in conjunction with each other identify opportunities to integrate the services of the local health system to provide appropriate, co-ordinated, effective and efficient services. The Local Health System Integration Act clearly lays out the responsibility and obligation for LHINs and Health Service Providers to seek out opportunities to integrate services. The proactive identification of integration opportunities is new territory for this LHIN. As a regional planning body, it is time for Toronto Central LHIN to begin to drive system transformation and achieve improved client and patient outcomes through integrations. With clarity of purpose, strength of conviction, courage to drive for improvements, along with an unwavering commitment from the health service providers, there is potential for an exponential improvement in client and patient service and experience through a combination of voluntary and LHIN facilitated integrations. In order to thoughtfully build on the success of voluntary integrations and move in this new direction, an objective third party review of the Toronto Central LHIN integration pathways and current experience is necessary. The review would explore and recommend courses of action that both maintain the proven success of voluntary integrations, and also move Toronto Central LHIN in this new direction. Toronto Central LHIN staff will report on the results of the third party review at a future Board meeting MOTION No motion. Agenda Item 7 Emergency Preparedness TOPIC: LHIN Pan/Parapan American Games Preparedness BACKGROUND: Toronto Central Local Health Integration Network (LHIN) has assumed the responsibility for health system emergency preparedness across the seven LHINs hosting venues for the Pan Am and Parapan Am Games (Games) in July-August Toronto Central LHIN is using this as an opportunity to build overall preparedness and capability for emergency response. Toronto Central LHIN has developed a plan for standardization of communication and coordination architecture for emergency planning and response, as well as clarifying doctrine and providing emergency preparedness training. All of our partners from across the TC LHIN Board of Directors Meeting, February 25,

20 health and community sectors have been highly encouraged to review and exercise their own, internal emergency preparedness plans as part of this effort. This included funding sessions to train ten community agencies in how to draft Emergency Management Plans, the templates of which were then shared across the LHIN, and made available to the six LHINs in the Games footprint. Health and Community partners within the Games footprint have been divided, by LHINs, into three zones designed to expedite communications between the wider arching organizations, such as the Ministry s Emergency Management Branch and Toronto 2015 (the Games). Key subjects for communications have been identified as Priority Information Requirements (attached), and their import communicated to the organizations within this architecture. Toronto Central LHIN has also led the development of an electronic communications dashboard that will be implemented in time for the Games. This Emergency Management Communications Tool will incorporate a variety of inputs to provide secure, near real-time dissemination of relevant information across the health sector within the Games footprint. This includes, but is not limited to, syndromic surveillance, transportation, and bed capacity information. The University Health Network volunteered to lend their extensive experience in technological procurement to this effort. Following a Request For Proposals the contract was awarded to Buffalo Computer Graphics, who are also supplying a similar system to the Games organization, and have just been chosen to provide the same technology to the City of Toronto. The intent is for this to be maintained as legacy system for emergency communications after the Games. The first of 14 exercises in advance of the Games was carried out in early September 2014, and others have followed based on geography and Games venues. These exercises vary in scope and scale from the level of individual partners to coordinated, federally-led response. The exercises are tailored towards building an awareness of the various roles, responsibilities and modi operandi of different organizations, information sharing, and the validating systemic readiness. Toronto Central LHIN worked aggressively to ensure that exercises were designed to address issues raised by the Hazard Identification and Risk Assessments conducted by the province. Toronto Central LHIN has pursued new initiatives in clarifying policy and planning for the long term. At our request, the Ministry s Emergency Management Branch has circulated a memorandum with their expectations of what roles the LHINs will assume in an emergency management situation during the Games (see attached), while a longer term document continues to be worked on. Sunnybrook has agreed to partner with Toronto Central LHIN as the lead hospital, not just in the preparation for the Games, but as a long-term hospital leader in Emergency Planning and Response within the City of Toronto. In addition Toronto Central LHIN has also introduced the concept of a new, annual cycle of emergency preparedness within the Greater Toronto Area, where training and development can be forecasted every year. NEXT STEPS: System plan, for the short term, is to achieve Operational Functional Point, with all LHINs and associated organizations ready for the Games, no later than June 16, For the longer term, it is to sustain gains made through an annual training and review cycle, use and maintenance of the Emergency Management Communications Tool, and expand those applicable throughout the province. The Board will receive a presentation on this topic at the meeting. Agenda Item 8 Approval of Minutes of November 26, 2014 To be posted to website once approval made by the Board. TC LHIN Board of Directors Meeting, February 25,

21 Agenda Item 9 Consent Agenda Copies of the Q3 CEO Report will be available at the meeting. TOPIC: CONSENT AGENDA - CEO Certificate of Compliance PURPOSE OF THIS AGENDA ITEM Provide the Board with a copy of the CEO Certificate of Compliance for the period October 1, 2014 to December 31, BACKGROUND: CEO Toronto Central LHIN Management must comply with all applicable government laws and remittances, in accordance within the terms below: Tax holding payment Payroll benefits payment Monthly financial preparations Health and safety Legality Insurance The Ministry of Health requires the LHIN to submit a Board approved Attestation on a quarterly basis. To align with the Ministry process, on a quarterly basis, at a Senior Management meeting, the CEO, Senior Director and Controller will review all items on the CEO Financial and Compliance Certificate to ensure that there are no irregularities. If all are in compliance, the CEO, Senior Director and Controller sign and submit the certificate to the Board. However, if such irregularities are found, these will be noted. MOTION: No motion required TC LHIN Board of Directors Meeting, February 25,

22 TOPIC: CONSENT AGENDA - Chair s Attestation (Certificate of Compliance) PURPOSE OF THIS AGENDA ITEM The Board to authorize the Chair to sign and submit the Chair s Attestation (Declaration of Compliance) for the period October 1, 2014 to December 31, BACKGROUND: LHIN Board Chairs are required to provide a signed Declaration of Compliance, due each quarter on the following dates: January 31 April 30 July 31, and October 31 MOTION: That the Toronto Central LHIN Board of Directors authorizes the Chair to execute and submit the Chair Attestation (Declaration of Compliance) to the Ministry for the 2014/15 third quarter. TOPIC: MINISTRY-LHIN PERFORMANCE AGREEMENT NEGOTIATIONS PURPOSE OF THIS AGENDA ITEM: To seek approval by the Board of Directors to authorize a Work Group to represent the Toronto Central LHIN at negotiations regarding the Ministry-LHIN Performance Agreement (MLPA). BACKGROUND: In areas where LHINs need to act in together such as the negotiation of the provincial Ministry-LHIN Performance Agreement or the Ministry-LHIN Memorandum of Understanding (MOU) the MOU requires that each LHIN must respect and abide by the position approved by a two-thirds majority of LHINs (Ministry-LHIN MOU, Section 14.2 b). TC LHIN Board of Directors Meeting, February 25,

23 The 14 LHIN Chairs and CEOs meet regularly and have established a process to identify a Committee or Work Group in such cases in order to represent the LHINs in their negotiations with the ministry. The Work Group, consisting of two Chairs and two CEOs, are given a mandate to act on behalf of the LHINs in discussions with the Ministry of Health and Long Term Care and report back on their progress throughout the negotiations. The current MLPA was negotiated using a similar process in early 2013, at the time called a Ministry-LHIN Joint Advisory Committee, which consisted of LHIN CEOs, Chairs, and LHIN Legal and Ministry officials. In keeping with governance best practice, Toronto Central LHIN should provide the MLPA negotiating committee the mandate to act on their behalf, and provide input on areas of focus for the committee during discussions with the ministry. MOTION: The motion below authorizes the provincial MLPA Negotiating Work Group to carry out discussions with the ministry with the goal to achieve a new MLPA agreement for 2015/16. Note that because of a misstep in the process, the Work Group has already met with the ministry to begin negotiations prior to receiving its formal mandate from LHIN Boards. Preliminary discussions, to date, have: (1) been consistent with the mandate proposed in this note and (2) have not resulted in any commitments on behalf of the LHINs. However, Toronto Central LHIN would like to ensure that appropriate governance processes are in place and our input is given about suggested areas of focus. The enclosed attachment outlines the LHINs expectations regarding the process and principles guiding the Work Group, as well as a summary of key areas of focus for the Work Group to consider during negotiations. MOTION: The Toronto Central LHIN Board of Directors hereby authorizes a Work Group with representation from LHIN Legal Services, LHIN CEOs (Erie St. Clair and Waterloo Wellington LHINs) and Board Chairs (North Simcoe Muskoka and Mississauga Halton LHINs) to act on behalf of the Toronto Central LHIN to coordinate and manage the negotiation process for the renewal of the LHIN- Ministry Performance Agreement for 2015/16, with a focus on two key areas of discussion: (1) improved alignment of performance indicators to the ministry s mandate and priorities; and (2) working towards an agreement that reflects a true partnership between the ministry and LHINs with a focus on outcomes. TC LHIN Board of Directors Meeting, February 25,

24 ATTACHMENT A: MLPA NEGOTIATING WORK GROUP MANDATE MANDATE: In keeping with ministry objectives for the negotiations, the Work Group is tasked with negotiating a new MLPA template agreement (the current agreement is in effect until March 31, 2015). PROCESS AND PRINCIPLES: Mandate a clear mandate and key areas of LHIN interest will be provided to guide the Work Group s negotiations. Accountability the accountability of the Work Group is to the 14 LHINs. Scope the Work Group has the scope to make decisions on behalf of the LHINs to achieve a draft agreement and will ensure that emerging issues are brought back to the LHINs for consultation as needed. Communication the Work Group will provide regular updates on the progress of the negotiations. Focus on shared interests recognizing that the final negotiated agreement may impact LHINs differently, the focus of the Work Group will be on achieving, as much as possible the collective, shared interests of LHINs. AREAS OF FOCUS: Given the speed of transformation in Ontario today, it is imperative that the MLPA reflect current provincial priorities and support a robust and effective working relationship between LHINs and the ministry over the term of the agreement. Two key areas of focus for the Work Group are: Improved alignment of performance indicators: working towards a system in Ontario where the ministry s mandate and priorities translate into provincial measures that are incorporated into the MLPA and cascaded to health service providers through local Service Accountability Agreements. Reflecting a True Partnership between the ministry and LHINs: as LHINs have continued to mature and evolve, so too should the partnership with the ministry. To the extent possible, the new agreement should avoid addressing individual performance issues and focus on outcomes over processes. Agenda Item 10 Finance and Audit Committee Report TOPIC: Toronto Central LHIN s Q3 Consolidated Financial Results Report (unaudited) TC LHIN Board of Directors Meeting, February 25,

25 PURPOSE OF THIS AGENDA ITEM Approval of the 3 rd Quarter Consolidated Financial Results Report for Toronto Central LHIN (unaudited). Management provides its consolidated financial results report to the Finance and Audit Committee each quarter on how it allocates funding for the operations of TC LHIN and LHIN Shared Services. The attached consolidated report includes the financial operating results of Toronto Central LHIN and LHIN Shared Services (LSSO, Legal and LHINC) for the nine months ended December 31, TC LHIN Consolidated Operations At the consolidated level, TC LHIN is reporting a year-to-date positive budget variance of $320K for the 3 rd Quarter ended December 31, 2014 due primarily to the timing of expenditures and receipt of funding from the LHINs. TC LHIN expects to have a balanced budget at year-end March 31, The consolidated cash balance of $3.0M is sufficient to cover obligations over the next quarter. The Finance and Audit Committee reviewed the TC LHINs financial results reports in detail and recommends that the Board approve the consolidated report. MOTION That the Board of Directors hereby approve the Q3 2014/15 Consolidated Financial Results Report (unaudited). TOPIC: Toronto Central LHIN s 3 rd Quarter Surplus Funds Reallocation PURPOSE OF THIS AGENDA ITEM To inform the Board of Directors on the TC LHIN Q HSPs Surplus Funds Reallocation status. BACKGROUND: The HSPs Surplus Funds Reallocation report for the 3 rd Quarter ended December 31, 2014 summarizes the year-to-date surplus funds reallocation funding stream, a subset of the total HSPs transfer payment. The total surplus reallocation was $4.71M as of the 3 rd Quarter ended December The source of surplus funds available for reallocation for the fiscal year 2014/15 comes from funds recovered from community health service providers as a result of the quarterly forecasted surplus due to the timing of the funding announcement. TC LHIN Board of Directors Meeting, February 25,

26 SURPLUS FUNDS REALLOCATION PLANNING The surplus funds recovered is reallocated to other community HSPs as one-time investment opportunities to support projects and initiatives that will further the TC LHIN planning efforts in system transformation. TOPIC: TC LHIN s Health Service Providers (HSPs) Operation Transfer Payment Funding PURPOSE OF THIS AGENDA ITEM To provide the Board of Directors with the 3rd Quarter HSPs Operation Transfer Payment Funding. BACKGROUND: The HSPs Operation Transfer Payment Funding report summarizes the 3 rd Quarter financial results for HSPs operation transfer payment funding. The HSPs operation transfer payments are funded by the Ministry of Health and Long-Term Care (Ministry) and more than 99% of the funding is nondiscretionary. The 1% discretionary funding is derived from urgent priority funds, community sector investment funding, and surplus reallocation in which TC LHIN has limited or full discretion to allocate the funds. HSP OPERATION TRANSFER PAYMENT FUNDING RESULTS The HSP transfer payment budget was created using the opening base amount from the Ministry LHIN Performance Agreement for The total base budget is $4.6BN as of the 3 rd Quarter ended December As of December 2014, the total transfer payment flowed for HSP operations was $3.49BN, with a positive variance of $28M due primarily to timing of the funding announcement, including community funding of $12.5 M. The detailed of this is discussed further in next item (under discretionary section). The total TC LHIN transfer payment funding to be flowed to HSPs as of March 31, 2015 will match with the amount of funding received from the Ministry. While the TC LHIN is forecasting a balanced budget at year end, March 31, 2015 and expects to flow the total base budget of $4.6B, the Toronto Central Community Care Access Centre (TC CCAC) may have a shortfall. The TC LHIN applied for and received a balanced budget waiver for the TC CCAC. The TC LHIN is working with the TC CCAC to balance its budget next year. The discretionary funding is discussed in a separate briefing note. TOPIC: Community Investment Discretionary Funding Q3 Allocation PURPOSE OF THIS AGENDA ITEM To report to the Board of Directors on Community Investment Discretionary Funding Allocation for the 3 rd Quarter of TC LHIN Board of Directors Meeting, February 25,

27 BACKGROUND: In November 2014, the Toronto Central LHIN has received notification from the Ministry a total of $12.44M community funding for the fiscal year, to be annualized to $14.70M in the 2015/16 fiscal year. The breakdown and conditions placed on the funding by the ministry are as follows: Mental Health and Addictions sector (MHA): $2.0M in 2014/15 to be annualized to $4.26M in 2015/16 to support phase 2 of the 10 year Comprehensive Mental Health and Addictions Strategy; Other community sectors targeted community investments: $3.41M to support government priorities, implementation of regulatory amendments to the Home Care and Community Services Act (HCCSA) for agencies other than Community Care Access Centers (CCACs) to provide personal support services for low acuity clients, and community leasehold expenses; and CCAC: $7.03M to achieve and maintain a five day wait time target for in-home personal support services for clients with complex needs, and for home nursing services. While TC LHIN has limited discretion with respect to the allocation of $7.03M for CCAC, it has some discretion with the allocation of $2.0M MHA sector funding and $3.41M community sectors funding. FUNDING ALLOCATION APPROACH: With a goal of maximizing impact and optimizing outcomes, TC LHIN allocated the discretionary funds based on the board approved investment approach as discussed in the April 2014 Board of Directors meeting. A detailed description of the investment approach can be found in Attachment A. The areas of focus as indicated in the investment approach are summarized below: Enhancing Access Initiatives focused on improving access to key services for complex, vulnerable and at-risk populations (e.g. Access to Specialists, Integrated Community Access) Enhancing Capacity Initiatives focused on addressing key service gaps for priority populations Initiatives that build on prior year investments (e.g. high support housing) to address system pressures and support right place of care Enabling System Change Continuing our focus on innovative/ evidence based service delivery models (e.g. children and youth) Build on successful proof of concept initiatives (e.g. chronic disease initiatives) Building Community Infrastructure Invest in enablers to care delivery processes to create a more integrated, coordinated system, and improve client transitions and experience with health care system Mental Health and Addition and Other community funding TC LHIN allocated the community funding based on prior year allocations and new HSIP submissions received this year; with the remaining balance of the Mental Health and Addition funding allocated using the Call for Proposal Process. There are five categories of call for proposals including: High Support Housing Supported Housing Peer Support Programs Family/Caregiver Support Programs Integrated Care Teams A total of 80 proposals were received from health service providers, with a total of $25.64M funding requested. TC LHIN Board of Directors Meeting, February 25,

28 TC LHIN allocated the funds based on the areas of focus indicated above, by using a four-phased evaluation methodology. The balance of community funding received was allocated to support targeted capacity enhancements aligned with ministry guidelines and local system needs. OUTCOME: The following describes the community investment outcome for the Mental Health and Addiction and community funds based on the four areas of focus: Area of Focus Enhancing Access Enhancing Capacity Enabling System Change Building Community Infrastructure Expected Outcomes Improve access initiative related to planning and coordination Clients Clients Strengthen right place of care FINANCIAL SUMMARY: The year-to-date Mental Health and Addictions and other community allocation for the 14/15 fiscal year and the planned allocation for the 15/16 fiscal year, categorized by the area of focus are summarized below: Area of focus Enhancing Access Enhancing Capacity Enabling System Change Building Community Infrastructure YTD Allocation 1,465,700 3,131, , , Planned Base Allocation 2,325,341 4,531, , ,000 Total Funding available $ 5,412,700 $ 7,672,600 For the unallocated funds from the 15/16 fiscal year, TC LHIN will allocate the funds according to the board approved investment approach in the 15/16 fiscal year. A detailed year-to-date allocation table categorized by the area of focus can be found in Attachment B. CCAC funding TC LHIN has allocated the funding in full in January 2015 in accordance with the Ministry guideline. TC LHIN Board of Directors Meeting, February 25,

29 TOPIC: TC LHIN s Budget Assumptions 2015/16 PURPOSE OF THIS AGENDA ITEM To provide the Board of Directors with an update regarding the process to develop TC LHIN s draft budget for 2015/16. Toronto Central LHIN s fiscal year ends on March 31, Typically, each January, management tables the draft budget and assumptions for review and input by the Finance and Audit Committee. This year, the LHIN is anticipating some budget information and directions from the Ministry of Health through the Ministry Management Committee. (Ministry Management Committee (MMC) is a Ministry driven Committee comprised of LHIN CEOs and the Ministry s senior management team. The Committee typically meets monthly to discuss LHIN/Ministry priorities and direction setting) MMC met earlier in February. Management recommended and the Finance and Audit Committee agreed to hold our budget assumptions development until this meeting has taken place and the LHIN will have more information on the Ministry s directions. Management will be preparing a draft budget and assumptions for the Finance and Audit Committee meeting in April. TOPIC: Toronto Central LHIN Year End Audit Plan 2014/15 PURPOSE OF THIS AGENDA ITEM Approval of the 2014/15 Toronto Central LHIN Year End Audit Plan. BACKGROUND: Deloitte presented its proposed Audit Plans for fiscal year 2014/15 to the Finance and Audit Committee and the LSSO/LHINC Audit Subcommittee in January Deloitte presented two separate Audit Plans 1) Toronto Central (TC) LHIN and 2) its divisions LHIN Shared Services Office (LSSO) and LHIN Collaborative (LHINC). However, Deloitte will give an audit opinion on the consolidated financial statements of TC LHIN for 2014/15 which includes its two divisions, LSSO and LHINC. As a corporate entity, the TC LHIN s CEO, CFO, management, and the Board are responsible for the consolidated financial statements. The LSSO/LHINC Audit Subcommittee supports the Finance and Audit Committee in fulfilling its oversight responsibilities by reviewing and recommending the terms of engagement of the annual audit plan, including scope and fees as well as the appointment of the external auditor. The Audit Subcommittee reviewed the year end audit plan for LSSO and LHINC and recommended that the Finance and Audit Committee bring them forward for Board approval. The Audit Service Plan for the TC LHIN, includes: - audit scope - audit strategy TC LHIN Board of Directors Meeting, February 25,

30 - audit approach - areas of audit risks The estimated fees for 2015 audit are: o TC LHIN $15,900 o LSSO $6,180 o LHINC $5,110 o Financial Management Branch (FMB) $15,790 There is a slight increase of $920 in the fees as compared to the 2014 fee schedule and based on the contract extension, the 2015 fees will not change for the next three years. The Finance and Audit Committee reviewed each of the year end audit plans in detail and recommend them for approval by the Board of Directors. MOTION: That the Board of Directors approve the 2014/15 Audit Plans for TC LHIN, LSSO, and LHINC. TOPIC: Annual Business Plan 2015/16 PURPOSE OF THIS AGENDA ITEM: To update the Board of Directors about the changes to the 2015/16 Annual Business Plan submission timeline. BACKGROUND: On an annual basis, each Local Health Integration Network (LHIN) develops an Annual Business Plan, which outlines how they will implement the health care strategies and objectives for their communities. The Annual Business Plan is a Ministry of Health and Long-Term Care (Ministry) template and requires LHINs to use the Integrated Health Service Plan as the framework for describing health strategies and investments. Our usual process has been to provide the Finance and Audit Committee with a draft Annual Business Plan for review in January prior to the initial submission to the Ministry for comment. Our work has evolved since the development of the Integrated Health Service Plan for example the health system has seen the implementation of transformational initiatives such as Health Links and is undergoing a shift to designing for population health. This report is therefore not a good reflection of our current activities. While the Integrated Health Service Plan does not expire until 2016, we are undertaking an update to our Strategic Plan in order to better reflect how our activities support the priority objectives we have set. This process will be ongoing to March 2015, at which time the Board of Directors will be presented with a refreshed Strategic Plan for approval. TC LHIN Board of Directors Meeting, February 25,

31 PROCESS FOR 2015/16 ANNUAL BUSINESS PLAN: Our aim is to bring alignment between the Annual Business Plan and the Strategic Plan however the reporting format and timelines do not currently align. To meet our goal we have discussed options with the Ministry and they have agreed to the use of the updated Strategic Plan as the framework for our new Annual Business Plan. To allow for the use of this information in the new Annual Business Plan the associated timeline needs to be modified to align with the strategic refresh timeline. To that end, the Finance and Audit Committee agreed to an amended process this year and the draft 2015/16 Annual Business Plan will be provided directly to the Board of Directors for review in March TOPIC: Toronto Central LHIN s Current Risk and Strategic Issue Management Report PURPOSE OF THIS AGENDA ITEM To provide the Board of Directors with TC LHIN s current priority Risks and Strategic Issues Report. BACKGROUND: The attached document has been developed by Senior Management to identify potential risks and current strategic issues. Each risk and strategic issues has been rated based on its likelihood of occurring and impact on TC LHIN. The risks and strategic issues reported on the attached document reflect the highest ranked risks and strategic issues. As well, Senior Management s confidence in the mitigation plan for each risk and strategic issue is presented. DEFINITION: Risk: An uncertain event or condition that, if it occurs, has a negative effect on a TCLHIN's strategic objectives or operations. Strategic Issue: A current condition that has the potential to impact on the success of a TC LHIN strategic direction or the achievement of the Ministry LHIN Performance Agreement (MLPA). CURRENT PRIORITY RISKS: 1. CCAC 14/15 forecasted deficit and potential need for MSAA waiver.(see Attachment C) 2. No funding mechanisms to accommodate growth in Hospital Emergency Department services in the downtown Toronto core. 3. LTCH bed shortage may lead to a significant increase in ALC across the TC LHIN. 4. QBP Funding shortfall impacting Total Joint Replacement Rehabilitation Capacity. 5. Mental Health & Addictions Service Capacity in the TC LHIN. 6. Sustainability of SRI reporting mechanisms and the impact on performance management capabilities. 7. Women's Withdrawal Management Facility Lease Termination. 8. Potential service reductions in Academic Health Science Centres related to recent change in the HBAM model regarding Level of Care. 9. Ongoing shortfall in CCAC School Program. 10. Potential for service changes related to shrinking revenue sources for HSPs including multiple years without inflationary increases. TC LHIN Board of Directors Meeting, February 25,

32 CURRENT PRIORITY STRATEGIC ISSUES: 1. Value of OCAN and RAI-CHA data will not be realized as integrated reporting of data and visibility of data by LHINs is not occurring. 2. Privacy Regulation for System Planners MOTION: None Agenda Item 11 Long Term Care Home Capacity Planning TOPIC: Long Term Care Capacity Planning in Toronto Central LHIN PURPOSE Approval of a proposal to develop a Long Term Care Capacity plan for the GTA and request Central, Central East, Central West and Mississauga Halton LHINs to participate. Background Long-term care home capacity in Toronto Central LHIN consists of 36 long-term care homes representing 5,878 beds. The purpose of this note is to provide an overview of the major issues facing long term care in Toronto Central LHIN, the context within which long term care operates in this LHIN and within the region, and recommendations on how best to move forward with planning for appropriate long term care capacity in Toronto Central LHIN. Occupancy in the long-term care homes is consistently high. The September 2014 occupancy rate was 99.66%. The Toronto Central Community Care Access Centre (CCAC) reported in November 2014, that the consistently high occupancy in long-term care has resulted in longer waits in hospitals and in the community for placement. The Toronto Central CCAC has seen a 20% and 79% increase in the average days to placement from both community (from 150 to 180 days) and hospital (from 70 to 125 days) respectively. Context The Profile of Long Term Care within the Broader Health Care System Long term care homes are an integral part of an interconnected broader health care system in Toronto Central LHIN that reaches throughout the City of Toronto, well beyond the Toronto Central LHIN boundaries. The Toronto Central LHIN long term care homes operate among approximately 85 long term care homes and about 15,000 long term care beds within the City of Toronto. Long term care homes also operate within a spectrum of care for seniors and adults requiring assistance with essential activities of daily living. The spectrum of care can be described as follows: Long Term Care: Long term care home residents need to live in a residential setting where there is the availability of nursing and personal care services on a 24 hour 7-day a week basis. Daily meals and other TC LHIN Board of Directors Meeting, February 25,

33 programs and support services are also provided to individuals who can no longer live independently in their own homes but need the assurance of protective oversight in a residential setting. Supportive Housing: Clients live independently but require personal support services to be available on a 24hour 7-day a week basis. Services are delivered in clustered housing models such as in a retirement home, apartment building, or within a tight radius in a neighbourhood. Nursing is provided on a visitation basis as determined by the Toronto Central CCAC. Other community support services are made available on a prescheduled basis. Community Care Access Centre Services: Clients live independently in their own homes but need professional services such as nursing, physiotherapy, etc., and / or personal support services to be provided on a scheduled visitation basis in order to maintain that independence. Community Care Access Centres determine eligibility for these professional and personal support services and make arrangements for services to be delivered. Community Care Access Centres also determine eligibility for placement into a long term care bed and manage the waiting lists for long term care homes. Acute Care Hospital Long Term Care Supportive Housing Community Support Services: Clients may receive a variety of support services in their own homes or participate in centrebased activities, all of which, support independent living in the community. These services include: meals on wheels, transportation to medical and other appointments, structured activities in an adult day program, etc. Post Acute Hospital Client / Resident/ Patient Community Support Services Community Care Access Center Post-Acute Hospital: Patients, typically after an acute hospital stay, may require rehabilitation or complex continuing care on an in-patient basis. These patients may be medically unstable, or require services on a much more intensive basis than can be provided at home or in a long term care home. Acute Care Hospital: Patients require immediate medical services to treat an illness or injury. The spectrum of health care services is not linear in that a client or patient s needs may change over time and therefore will move in and out of several components of the broader health care system. Typically, long-term care, supportive housing, and the community are viewed as the destination points within the broader health care system for individuals where they remain on a permanent basis. As of February 6, 2015, Toronto Central LHIN long term care homes have a combined waiting list of 3,982. The chart below illustrates the point of origins for individuals waiting for a long term care bed in Toronto Central LHIN. Table1 Current Location Type of Residence * Number Percentage Hospital 293 8% Acute Care 124 Post-Acute Care 169 Community Private Dwelling 2,195 55% Long Term Care Waiting for Transfers 1,368 34% Retirement Home 125 3% TC LHIN Board of Directors Meeting, February 25,