JOINT SPECIAL COUNCIL MEETING to be held on Monday, February 1, 2016 at 7:00 p.m. in the Huntsville Civic Centre, Algonquin Theatre A G E N D A

JOINT SPECIAL COUNCIL MEETING to be held on Monday, February 1, 2016 at 7:00 p.m. in the Huntsville Civic Centre, Algonquin Theatre A G E N D A 1. ADOPTION OF AGENDA 2. DISCLOSURE OF PECUNIARY INTEREST 3. INVITED PRESENTATIONS 3.1. Defining a Contemporary Health System to Better Serve Muskoka and Area Residents and Visitors - Rob Alexander, Chair and Sven Miglin, Vice Chair Hospital Retention Working Group (Huntsville); Bradley Campbell, President, CSI Consultancy Inc. (Bracebridge) 4. NEW BUSINESS 4.1. Motion of Council - Proposal to NSM LHIN Healthcare Task Force 2-33 5. CONFIRMATION BY-LAW 6. ADJOURNMENT 1 of 33

CORPORATION OF THE TOWN OF HUNTSVILLE CORPORATION OF THE TOWN OF BRACEBRIDGE Huntsville/Bracebridge Joint Town Council Date: February 1, 2016 No. Moved by: Seconded by: BE IT RESOLVED THAT: The proposal for a Contemporary Health System to Better Serve the Residents of Muskoka from Bracebridge Mayor Graydon Smith and Huntsville Mayor Scott Aitchison, as presented on February 1, 2016, be endorsed for presentation to the North Simcoe Muskoka Local Health Integration Network (NSM-LHIN) Healthcare Task Force; AND FURTHER THAT: The members of the Task Force representing Muskoka Algonquin Healthcare (MAHC) and the NSM-LHIN be encouraged to consider the recommendations set out in the proposal as a framework for the development of a mutually acceptable long-term hospital service plan for the area serviced by MAHC; AND FURTHER THAT: The proposal for a Contemporary Health System to Better Serve the Residents of Muskoka be circulated to the municipalities in the District of Muskoka, and other municipalities in the MAHC catchment area for endorsement; AND FURTHER THAT: The proposal for a Contemporary Health System to Better Serve the Residents of Muskoka be circulated to MPP Norm Miller and MP Tony Clement for their information; AND FURTHER THAT: The Mayors report back to each Council and the other area municipalities on the deliberations of the Healthcare Task Force as additional information becomes available. RECORDED VOTE DECLARATION OF PECUNIARY INTEREST MEMBERS OF COUNCIL YEA NAY MEMBERS OF COUNCIL PERSONAL BUSINESS EMPLOYMENT OTHER Town of Huntsville Councillor Alcock Councillor Armour Councillor FitzGerald Councillor Schumacher Councillor Stone Deputy Mayor Terziano Councillor Thompson Councillor Wiebe Mayor Aitchison Town of Bracebridge Councillor Buie Councillor Clement Councillor Giaschi-Pacini Deputy Mayor Maloney Councillor McMurray Councillor Quemby Councillor D. Smith Councillor Wilson Mayor G. Smith TOTAL Town of Huntsville Councillor Alcock Councillor Armour Councillor FitzGerald Councillor Schumacher Councillor Stone Deputy Mayor Terziano Councillor Thompson Councillor Wiebe Mayor Aitchison Town of Bracebridge Councillor Buie Councillor Clement Councillor Giaschi-Pacini Deputy Mayor Maloney Councillor McMurray Councillor Quemby Councillor D. Smith Councillor Wilson Mayor G. Smith TOTAL Carried: 2 of 233 of 33

Joint Report to Town Council Mayor G. Smith, Town of Bracebridge Mayor S. Aitchison, Town of Huntsville TO: FROM: Members of Council, Town of Bracebridge and the Town of Huntsville Mayor Graydon Smith Mayor Scott Aitchison COPY: District of Muskoka; all Municipalities in Muskoka; other Municipalities in the MAHC Catchment Area; NSM Local Health Integration Network; Muskoka Algonquin Healthcare; MPP N. Miller; and MP T. Clement DATE: February 1, 2016 SUBJECT: Proposal for Submission to the North Simcoe Muskoka Local Health Integration Network (NSM-LHIN) Healthcare Task Force RECOMMENDATION 1. BE IT RESOLVED THAT: the proposal for a Contemporary Health System to Better Serve the Residents of Muskoka from Bracebridge Mayor Graydon Smith and Huntsville Mayor Scott Aitchison, as presented on February 1, 2016, be endorsed for presentation to the North Simcoe Muskoka Local Health Integration Network (NSM-LHIN) Healthcare Task Force. 2. AND FURTHER THAT: the members of the Task Force representing Muskoka Algonquin Healthcare (MAHC) and the NSM-LHIN be encouraged to consider the recommendations set out in the proposal as a framework for the development of a mutually acceptable long-term hospital service plan for the area serviced by MAHC. 3. AND FURTHER THAT: the proposal for a Contemporary Health System to Better Serve the Residents of Muskoka be circulated to the municipalities in the District of Muskoka, other municipalities in the MAHC catchment area for endorsement. 4. AND FURTHER THAT: the proposal for a Contemporary Health System to Better Serve the Residents of Muskoka be circulated to MPP Norm Miller; and MP Tony Clement for their information. 5. AND FURTHER THAT: the Mayors report back to each Council and the other area municipalities on the deliberations of the Healthcare Task Force as additional information becomes available. ORIGIN 6. As members of Council are aware, on May 27, 2015, the Board of Muskoka Algonquin Healthcare (MAHC) endorsed the concept of one centrally-located acute care hospital as the model for longterm hospital services for the area serviced by MAHC. Due to the significance of the decision by the MAHC Board and the potential impact of the decision on Bracebridge, Huntsville, other municipalities in Muskoka and municipalities in East Parry Sound included as part of the MAHC catchment area, resolutions supporting the continued delivery of multi-site acute care hospital services were passed by area municipalities. 7. In August 2015, MAHC filed a Pre-Capital Submission with the North Simcoe Muskoka Local Health Integration Network (NSM-LHIN) based on the single-site model. The Pre-Capital Submission is part of the Ministry of Health and Long-Term Care's Joint Review Framework for Early Capital Planning Stages. The Pre-Capital Submission is the entry point into the Ministry's capital planning process, which moves through a series of five distinct stages. Page 1. 3 of 33

Joint Report to Town Council Mayor G. Smith, Town of Bracebridge Mayor S. Aitchison, Town of Huntsville 8. On September 28, 2015, representatives from the Town of Bracebridge, the Town of Huntsville, the Town of Gravenhurst and Muskoka Lakes Township made a presentation to the LHIN Board outlining serious concerns with the hospital service delivery model proposed by MAHC. The presentation to the LHIN Board confirmed that Bracebridge, Huntsville and all of the communities in Muskoka recognize and appreciate the importance of the acute care hospital services provided by Muskoka Algonquin Healthcare; the dedication and hard work of the doctors, nurses and other staff who are part of the MAHC team; and the need to pro-actively conduct long-term planning for sustainable hospital services. 9. Notwithstanding the long-term support for MAHC demonstrated by Bracebridge, Huntsville and the other area municipalities, the LHIN was informed that the municipalities felt that the Pre- Capital Submission prepared by Muskoka Algonquin Healthcare and submitted to the North Simcoe Muskoka should be rejected and that MAHC should be instructed to undertake a new pre-capital planning process based on broad, comprehensive and meaningful community consultation, sound cost analysis with a true focus on integration, accessibility and the provision of patient-focused hospital services. 10. Specifically, the municipalities indicated that the following items must be included as key factors to be fully evaluated by Muskoka Algonquin Healthcare: Land use planning legislation and policies; Community economic impacts of any long-term plans for hospitals; The ability to raise the funds required for sustainable hospital services; Operating and cost impacts of any long-term plans for hospitals on both the lower and upper-tier levels of government including cost implications on Emergency Medical Services (EMS), water treatment services, sanitary sewer services, transit, etc.; and Direct impact on local healthcare service providers. 11. On October 26, 2015, the Board of Directors for the NSM-LHIN met to review the MAHC Pre- Capital Submission. During their discussion, the LHIN Board was clear that they recognized MAHC is faced with significant issues resulting from aging facilities and that the Board wishes to work closely with MAHC to advance the hospital s issues and plans to the Ministry of Health and Long-term Care. The Board Chair also acknowledged the issues and concerns raised by the area municipalities and was direct in saying that municipal support and understanding was necessary to advance local hospital planning through the Ministry. 12. After discussion, the resolution attached as Appendix A to this staff report was adopted by the LHIN Board. The Board Chair clarified that the LHIN needed to ensure that WHAT, HOW and WHERE issues were properly addressed in the proposals put forward by MAHC. The Board Chair confirmed that, although the WHAT issues were clearly addressed (i.e. the range and scope of services to be delivered by MAHC), further work was required around the HOW AND WHERE topics. To this end, the Board of Directors for the LHIN committed to working with MAHC and the area municipalities to examine the outstanding topics and to come to a locallyaccepted plan for the future. 13. The Board was clear that the resolution adopted was not an endorsement of either the single-site model or the location of any new hospital facilities. The LHIN s CEO indicated that work would begin immediately on development of terms of reference for a process whereby the LHIN, MAHC and the area municipalities could come together to develop a common perspective on how to move forward. Page 2. 4 of 33

Joint Report to Town Council Mayor G. Smith, Town of Bracebridge Mayor S. Aitchison, Town of Huntsville 14. Although the municipalities had proposed that MAHC s Pre-Capital Submission be rejected by the LHIN, it is recognized that the decision by the LHIN to adopt the resolution presented to the Board on October 26th is based on the goal of allowing MAHC s planning work to move forward to the Ministry while providing a mechanism for local engagement in the planning process to address many of the issues raised by the municipalities. 15. On October 30, 2015, the Towns received communication from the NSM-LHIN Chair inviting them to participate in a Healthcare Task Force. As noted in the terms of reference for the Task Force: The purpose of this project is to establish a common vision for acute care service delivery by Muskoka Algonquin Healthcare in Muskoka for the future. This common vision or agreement must be supported by local municipalities, the District of Muskoka, MAHC, NSM LHIN, and input and feedback from peripheral stakeholders in order for planning to be successful. As both the hospital and the local municipalities are reliant on one another it is critical that a common vision be established and that a commitment be obtained by all parties to work together moving forward with the capital planning process. 16. The Terms of Reference for the Task Force are attached as Appendix B. 17. As noted previously, it appears that the decision of the LHIN Board was based on recognition of the issues raised by the area municipalities. 18. Membership for this Task Force as established by the NSM LHIN is as follows: 18.1. Chair - Board Chair of the NSM-LHIN; 18.2. Vice-Chair - CEO of the NSM-LHIN; 18.3. MAHC - Board Chair, Chair, Strategic Planning Committee, CEO and Chief Executive Diagnostics, Ambulatory, Planning; 18.4. District of Muskoka - District Chair, CAO and Commissioner, Community Services; 18.5. Town of Huntsville - Mayor and CAO; 18.6. Town of Bracebridge - Mayor and CAO; 18.7. Other members as deemed appropriate by the Task Force; and 18.8. Resource person as required (staff and/or consultant). 19. A series of meetings for the Task Force were established in November and December 2015. 20. In accordance with the invitation from the NSM LHIN, both the Mayor and the Chief Administrative Officer for the Towns have participated in each of the meetings held by the LHIN. Information resulting from those meetings is being distributed to members of Council as it is made available by the LHIN. 21. After the first meeting, the membership on the LHIN s Task Force was expanded to include a Mayor representing the municipalities in East Parry Sound (Cathy Still, Reeve, Village of Burk s Falls) and a Mayor representing the Town of Gravenhurst, the Township of Lake of Bays, and the Township of Muskoka Lakes (Bob Young, Mayor of the Township of Lake of Bays). Page 3. 5 of 33

Joint Report to Town Council Mayor G. Smith, Town of Bracebridge Mayor S. Aitchison, Town of Huntsville 22. Additionally, the Task Force recognized that there may be instances when other individuals may be invited to act as a resource in Task Force discussions or to offer their perspectives, guidance, and expertise to the Task Force. The Task Force acknowledged that other resources would offer valuable perspectives and insights that could facilitate the work of the Task Force. 23. Since its formation, the Task Force has met on several occasions and has received a great deal of information related to the healthcare delivery system in Ontario and specifically in the MAHC catchment area. 24. Task Force Communiques and Meeting Summaries issued after each meeting of the Task Force are attached as Appendix C and Appendix D. 25. In response to the information presented to the Task Force and to facilitate development of a healthcare service delivery plan that could be acceptable to all of the parties participating in the meetings of the Task Force, the Towns of Bracebridge and Huntsville have developed the draft proposal for a Contemporary Health System to Better Serve the Residents of Muskoka which will be presented on February 1, 2016. Subject to approval by each municipal Council, the proposal would be presented to the Task Force for further consideration. ANALYSIS 26. As part of its process to finalize its pre-capital planning submission, MAHC tabled a proposal to replace the existing hospitals in Bracebridge and Huntsville with a new, single-site hospital facility to be located on a greenfield site roughly halfway between the two Towns. 27. This proposal raised a number of concerns from local municipal leaders, which led the NSM LHIN to establish a Task Force comprised of the LHIN, MAHC, the District of Muskoka and a number of municipal leaders to review the process that MAHC pursued to select its preferred option and determine if alternate options could be considered. 28. The municipalities acknowledge that MAHC has undertaken extensive work to develop its precapital planning submission and that the content is consistent with MOHLTC requirements. 29. The municipalities also acknowledge that MAHC s internal assessment of future options considered a number of key variables available at that time and that there are clearly benefits provided by a single site option. 30. Since that time however, there have been numerous changes in policy and in the financial situation at the Province that will affect MAHC and the LHIN. Additionally, the Task Force has provided the Municipalities the opportunity to share their planning strategies and objectives. 31. In light of these changes and the new perspectives presented, it is appropriate to consider an alternative model for hospital service delivery. The presentation on February 1, 2016 will set out a proposal for consideration by the Town Councils. LINKAGE TO COMMUNITY PLANS 32. The municipalities understand that a long-term sustainable plan for hospital services must be developed. Each municipality, including the District of Muskoka, has adopted a Vision or Mission that embraces health care as a priority. Page 4. 6 of 33

Joint Report to Town Council Mayor G. Smith, Town of Bracebridge Mayor S. Aitchison, Town of Huntsville 33. The Mission Statement of the District of Muskoka, as developed through the District s strategic planning process is: To manage the legacy of a healthy Muskoka by sustaining a functioning natural environment, recognizing the need for a vibrant economy together with a caring community conscience supporting those in need. 34. The Mission Statement of the Town of Bracebridge, as developed through the Town s strategic planning process is: Bracebridge is a progressive and well-planned community committed to embracing its citizens desires for a sustainable town that is healthy, green, creative and prosperous. 35. The Vision for the Future formulated by the Town of Huntsville is: Huntsville is a vibrant, welcoming and healthy place in which to live and play as we foster innovation, celebrate arts, culture, heritage, and recreation, develop a strong and resilient economy and follow an ethic of social caring and environmental stewardship. 36. The proposal for a Contemporary Health System to Better Serve the Residents of Muskoka as presented on February 1, 2016 is consistent with the priorities identified by each municipality. EXISTING POLICY 37. Both the Bracebridge and Huntsville Councils have, through several resolutions, supported the maintenance of acute care hospital services in both Bracebridge and Huntsville. 38. The proposal presented on February 1, 2016 sets out a health care delivery model that supports the continued provision of vital hospital services in both communities. COMMUNICATIONS 39. This report was distributed to the members of the Bracebridge and Huntsville Town Councils, local media, municipal staff and was published on the website of each Town in accordance with the Procedural By-laws of each community. 40. Additionally, note of this meeting and report has been provided to the municipalities in the District of Muskoka, the municipalities in East Parry Sound (that are part of the MAHC catchment area); MPP Norm Miller; and MP Tony Clement. Submitted by: Graydon Smith, Mayor Scott Aitchison, Mayor Page 5. 7 of 33

Joint Report to Town Council Mayor G. Smith, Town of Bracebridge Mayor S. Aitchison, Town of Huntsville Appendix A NSM LHIN Resolution October 26, 2015 WHEREAS on October 15, 2015, Muskoka Algonquin Healthcare submitted an updated Pre-Capital Submission Form Part A with respect to the redevelopment of its current hospital sites; and WHEREAS the Ministry-LHIN Accountability Agreement sets out the roles and responsibilities of LHINs with respect to capital initiatives proposed by a health service provider related to the construction, renewal or renovation of a facility or a site, including requiring the LHIN review Part A of the Pre-Capital Submission and provide advice and/or endorsement to the ministry; and WHEREAS in October 2010, the ministry provided LHINs and health service providers with a Ministry- LHIN Joint Review Framework for Early Capital Planning Stages Toolkit that included submission templates and LHIN review guidelines; and WHEREAS per the Joint Review Framework, LHIN review and advice to the ministry is based solely on Part A of the Pre-Capital Submission which focuses only on Program and Service elements; and WHEREAS Ministry review and approval of the pre-capital submission is based on both Part A as well as Part B which focuses on Physical and Cost elements which outlines the what that is to be provided; and WHEREAS further planning elements including but not limited to location of services, land use & economic impact will be captured in future stages of the capital planning process; and WHEREAS NSM LHIN staff have reviewed Part A of the Hospital s submission and determined that it addresses the requirements outlined in the Joint Review Framework; and WHEREAS over the next two months, NSM LHIN will facilitate further engagement between MAHC and the local communities (municipalities) to support enhanced awareness and endorsement for the future state health service delivery model; THEREFORE the planned programs and services must Meet current safety and quality standards; Fit into the broader system; Garner municipal support; and Take into account current fiscal realities BE IT RESOLVED THAT: The North Simcoe Muskoka LHIN Board of Directors endorses the Muskoka Algonquin Healthcare Pre- Capital Submission Part A (Programs and Services), in respect to the redevelopment of its current hospital sites. Page 6. 8 of 33

Joint Report to Town Council Mayor G. Smith, Town of Bracebridge Mayor S. Aitchison, Town of Huntsville Appendix B NSM LHIN Capital Planning (Healthcare) Task Force - Terms of Reference Page 7. 9 of 33

Terms of Reference Muskoka Algonquin Healthcare capital planning task force Background and Purpose: Muskoka Algonquin Healthcare (MAHC) has completed a Master Plan Master Program. This planning is aligned with the direction of the NSM LHIN to Drive Quality and Sustainable Service Delivery. The NSM LHIN received a pre capital submission from MAHC in August which was endorsed by the NSM LHIN Board of Directors at the October 26, 2015 meeting. There is some concern by the local municipalities regarding the service delivery model that has been presented by MAHC to deliver future services through a one site model, where services are currently delivered both in Huntsville and Bracebridge. The purpose of this project is to establish a common vision for acute care service delivery by Muskoka Algonquin Healthcare in Muskoka for the future. This common vision or agreement must be supported by local municipalities, the District of Muskoka, MAHC, NSM LHIN, and input and feedback from peripheral stakeholders in order for planning to be successful. As both the hospital and the local municipalities are reliant on one another it is critical that a common vision be established and that a commitment be obtained by all parties to work together moving forward with the capital planning process. Objectives Clarify expectations and purpose set out in the Project Overview and Terms of Reference Understand the direction of broader health service delivery in the future Establish planning principles for future acute care service delivery Review and further understand options evaluated Develop a common vision for acute service delivery in Muskoka Develop a go-forward approach to working together throughout the additional capital planning stages Membership: Chair Board Chair of the NSM LHIN Vice-Chair CEO of the NSM LHIN MAHC Board Chair, Chair of Planning Committee, CEO and Chief of Strategy Development District of Muskoka - District Chair and CAO Town of Huntsville - Mayor and CAO Town of Bracebridge - Mayor and CAO A Mayor representing the municipalities in East Parry Sound Township of Lake of Bays Mayor 10 of 33

Delegates: Given the executive nature of the Task Force, regular attendance at meetings by the members is critical. It is understood that at times, attendance for reason of illness, vacation or other urgent issues may require an alternate. The delegate should be a senior executive who has been properly briefed and able to make decisions in the absence of the committee member. Resources: There may be instances when other individuals may be invited to act as a resource in Task Force discussions or to offer their perspectives, guidance, and expertise to the Task Force. An invitation for a resource to attend a Task Force meeting is at the discretion of a member. Major Responsibilities of all committee members: Develop and support future plans for local service delivery Link and align with system priorities, regional councils and local implementation Facilitate change, members act as Change Agents Work inclusive of all key stakeholders Respond to an adaptive, complex health system Speak as one voice communication messages are clear Continuous evaluation Strengthen and inform accountability Inform the Chair if a resource is being invited to attend a Task Force meeting Distribute communique to their Council and/or Board Decision Making: The Task Force will strive to reach consensus. Unless consensus is reached, the Task Force will not have achieved the position of support necessary to move forward. At any time a Task Force member may require further discussion with their caucus, they will have an opportunity to do so prior to making a decision. Staff Resource Person to MAHC capital planning task force Administrative support will be provided by a corporate administrative team member of the NSM LHIN. Role and Responsibilities of the Chair: Facilitate the development and work towards the unanimous agreement of future acute care service delivery Encourage active participation of all members and when required seek the input of those beyond the Team Work with assigned resource person to prepare for meetings Facilitate the evaluation of the task forces work Role and Responsibility of the Staff Resource Person: Provide administrative support to the task force Act as the communication liaison between the task force members and other interested parties Assist the Chair with task force activities including: 1. Agenda development 2 11 of 33

2. Setting up meetings 3. Follow-up on key issues 4. Development and maintenance of reports and communication 5. Support and assist in evaluation Accountability: The Task Force is accountable to the LHIN Board of Directors Task Force will develop a communique following each meeting Task Force meetings will be open meetings, unless the agenda or topic warrants an in-camera discussion TimeLine: Beginning the week of November 9 th with initial findings to be completed by December 18 th 2015 and to include ongoing quarterly review for the following year Quorum: A majority of the members. Frequency of Meetings: Weekly or at the call of the Chair NSM LHIN Approval: original signed by Robert Morton, Board Chair Date Approved: November 16, 2015 3 12 of 33

Joint Report to Town Council Mayor G. Smith, Town of Bracebridge Mayor S. Aitchison, Town of Huntsville APPENDIX C NSM LHIN Healthcare Task Force - Communiques Page 8. 13 of 33

Muskoka Algonquin Healthcare Capital Planning Task Force Communiqué November 10, 2015 The initial meeting of the Muskoka Algonquin Healthcare Capital Planning Task Force was held on November 10, 2015 with the objectives of the meeting being to: Clarify expectations and purpose of the Task Force, and; Establish guidelines of engagement and fundamentals of dialogue. Key points of discussion on the Terms of Reference included a review of membership, decision making, communications and transparency. Membership on the Task Force was discussed and agreed upon, and is comprised of the following: NSM LHIN, Board Chair and Chief Executive Officer Muskoka Algonquin Healthcare, Board Chair, Chair Strategic Planning Committee, Chief Executive Officer and Chief Executive Diagnostics, Ambulatory and Planning District of Muskoka, District Chair and Chief Administrative Officer Town of Huntsville, Mayor and Chief Administrative Officer Town of Bracebridge, Mayor and Chief Administrative Officer In addition to the above it was suggested that an invitation be extended to the following to be included as members of the Task Force: A Mayor representing the municipalities in East Parry Sound A Mayor representing the Town of Gravenhurst, the Township of Lake of Bays, and the Township of Muskoka Lakes The Task Force recognized that there may be instances when other individuals may be invited to act as a resource in Task Force discussions or to offer their perspectives, guidance, and expertise to the Task Force. The Task Force acknowledged that other resources would offer valuable perspectives and insights that could facilitate the work of the Task Force. The group agreed that they must strive to reach consensus on the matters at hand and that, unless consensus is reached, the Task Force will not have achieved the position of support necessary to move forward. 14 of 33

Understanding requirements for acute care in Muskoka is a difficult task to undertake without a broad understanding and acknowledgement of the direction of health service delivery in the future. The Task Force recognized this and, while the scope of the project is to focus on acute care, the Task Force must undertake its work within the context of the broader system of healthcare services that will, or could be, available in the future. The Task Force recognized that a decision on the provision of acute care services in Muskoka in the future does not only impact Huntsville and Bracebridge, and that the focus of the Task Force must be on all residents of Muskoka and East Parry Sound. A strong desire and commitment to work together was obtained from all members. The Task Force made a commitment to ensure transparency both amongst the group and with all stakeholders. This commitment to transparency is evident through agreement to share joint communications on the work of the Task Force. As communication will be a critical component of the Task Force s success the establishment of key messages at the conclusion of each meeting was confirmed as a way to ensure that the group is collectively moving forward and to provide an opportunity for clarification on any of the key items discussed during the meetings. Any questions regarding the Muskoka Algonquin Healthcare Capital Planning Task Force, or this communication, can be directed to Leanne Vincent, Corporate Coordinator, NSM LHIN at leanne.vincent@lhins.on.ca or at 705 326 7750 ext. 216. 2 15 of 33

Muskoka Algonquin Healthcare Capital Planning Task Force Communiqué November 16, 2015 The second meeting of the Muskoka Algonquin Healthcare Capital Planning Task Force was held on November 16, 2015 with the objectives of the meeting being to: Understand initiatives impacting broader health care service delivery, and; Establish planning principles for health care service delivery. The meeting welcomed two new members to the Task Force Bob Young, Mayor, Township of Lake of Bays and Cathy Still, Reeve, Village of Burk s Falls. It was agreed at the initial meeting to expand the membership to include these representatives. The Terms of Reference for the Task Force were approved. Key points of discussion on understanding future health care service delivery focused on the following: Health Links Primary Care Home and Community Care Long-Term Care Health Links was a concept introduced by the Ministry of Health and Long-Term Care aimed to focus on a small number of individuals who utilize a large amount of health care resources. Health Links was derived to bring providers together to coordinate care by creating individualized coordinated care plans. What has been found is that these patients needs often fall outside of health care and are impacted by broader social determinants of health. The Health Link in Muskoka began two years ago and has provided coordinated care to highly complex individuals. Access to primary care is currently a gap for the residents in North Simcoe Muskoka. The Task Force heard that residents within the area served by the NSM LHIN are more likely than other Ontario residents to be attached to a primary care provider. However, they are less likely to be able to access the care of that provider when they need it. A shift in accountability for primary care providers would see patients being able to access care in a timely manner. The Task Force discussed what a reformed Primary Care system could look like in the future. The Task Force noted there would be fewer emergency room visits for conditions that are better managed in a primary care setting rather than in an acute care hospital setting if reforms to the primary care system were implemented. 16 of 33

Home and community care was reviewed in the context of needing to be connected to primary care. An overview was provided regarding how services differ between Community Care Access Centres. The Task Force heard there is a great degree of variability in how home care is provided and current reform is looking at greater standardization. In North Simcoe Muskoka there are a number of long-term care homes requiring redevelopment. This redevelopment will bring all homes to current approved Provincial standards. To be sustainable, longterm care homes are looking to redevelop at a minimum number of 96 beds. The NSM LHIN is looking at a LHIN wide approach to redistribution planning. While we do not want to lose any beds, there are no new bed licenses available provincially. The Task Force engaged in a rich and fulsome discussion about possible shifts or changes to health care service delivery in the future. Through this discussion, members of the Task Force gained a better understanding of how these services have historically been provided, as well as the vision for future acute care service delivery. Muskoka Algonquin Healthcare updated the Task Force on how on-going changes to health care service delivery will impact acute care hospitals in the future. Most notably, how primary care will be rooted as the hub of the system, and how patients having appropriate access to primary care will impact emergency room visits. A critical mass is necessary to achieve safe, high quality, sustainable health care services. The Task Force heard that, although the capital planning process for Muskoka Algonquin Healthcare projects acute care service needs in 2025 and beyond, there are implications for acute health care service delivery in the immediate future. Understanding the future directions of the health care system, in a context broader than acute care, is valuable information to be able to move forward with planning for the delivery of acute care hospital services. The Task Force did not discuss planning principles for health care service delivery. This will be discussed at the next meeting. Any questions regarding the Muskoka Algonquin Healthcare Capital Planning Task Force, or this communication, can be directed to Leanne Vincent, Corporate Coordinator, NSM LHIN at leanne.vincent@lhins.on.ca or at 705 326 7750 ext. 216. 2 17 of 33

Muskoka Algonquin Healthcare Capital Planning Task Force Communiqué December 2, 2015 The third meeting of the Muskoka Algonquin Healthcare Capital Planning Task Force was held on December 2, 2015 with the objectives of the meeting being to: Understand initiatives impacting the District of Muskoka and municipalities serviced by Muskoka Algonquin Healthcare, and; Establish planning principles for health care service delivery. The Task Force reviewed membership as concerns were raised about the membership not being inclusive of all municipalities in Muskoka. It was proposed that as the Task Force continues its work and gets to a position where all members feel that they could support a model for future acute care service delivery in Muskoka, broader consultation be held with all communities. The Task Force also recognized that the appointment of Cathy Still and Bob Young was done in consultation with other potential municipal representatives. There was discussion regarding media attendance at Task Force meetings, as the LHIN had received notification that media outlets were interested in attending. It was confirmed that the Task Force is working through a process and that there is a need for transparency. It was recommended that if any member of the Task Force was not comfortable having a discussion with the media present, the media would be excused from the meeting. It was reiterated that the Task Force is working through a process with the goal to achieve consensus. Information was provided regarding the Federal, Provincial and Municipal orders of government that form a complex structure within which governmental responsibilities are distributed. It was noted that municipal roles and responsibilities are set out in the Municipal Act and that, in accordance with the Act, both upper tier and lower tier municipalities have a specific interest in matters affecting the health, safety and well-being of persons within the municipalities and the general economic development of the community. It was noted that the District of Muskoka, the Town of Bracebridge, the Town of Huntsville and most other communities in Muskoka and East Parry Sound have Vision and/or Mission statements that highlight the importance of creating healthy, vibrant and sustainable communities. The Task Force heard that an important consideration in the selection of any site for a hospital facility must be the applicable provincial, district and local land use planning law and policy. 18 of 33

It was noted that land use planning decisions in Ontario must follow the Planning Act, be consistent with the Provincial Policy Statement (PPS), and conform to all applicable official plans. The Provincial Policy Statement applies province-wide. The PPS provides the policy foundation for regulating the development and use of land in Ontario. The policies work together to help build healthy communities, use and manage resources efficiently, and protect public health and safety. Careful consideration must be given to the location of acute care services in the future to ensure compliance with both provincial and local land-use planning legislation and policies. It was acknowledged that a long-term sustainable plan for acute care hospital services for the region in the future must be developed. The Task Force received information regarding a working group that had been formed in Huntsville to advise the Mayor and Huntsville Council regarding proposed changes at MAHC. It was noted that, in September, the group began working closely with Bracebridge to identify solutions that work across the entire MAHC catchment area. Information regarding several primary conclusions and initial recommendations of the working group was shared with the Task Force. The Task Force heard that Health System Funding Reform compensates hospitals based on the number of patients served, services delivered, quality of services, and specific needs of the broader population they serve. It is comprised of two models: Health-Based Allocation Model (HBAM); and Quality-Based Procedures Model (QBP). Together these models ensure funding is allocated based on the number of patients served and the procedures that are the most successful and efficient at delivering high-quality care. It was noted that HBAM is a provincial pie sharing model and that total funding under this model has been capped for some time. Funding to individual hospitals is relative to the health service provider performance compared to the performance of other hospitals across the province. The NSM LHIN confirmed that there are active reviews underway to understand any unintended consequences resulting from implementation of Health System Funding Reform and that they are actively participating in those reviews. The Task Force discussed how the seasonal population in Muskoka makes it unique. Seasonal population fluctuations influence municipal planning and the allocation of resources for health care service delivery. It is recognized that seasonal residents utilize municipal and healthcare services in Muskoka, even though they are not specifically accounted for in the population numbers for the region. The Task Force noted that there has been a great deal of work completed by Muskoka Algonquin Healthcare in developing the options considered for future acute care service delivery through their Master Plan/Master Program development process. The Task Force agreed that the next meeting will focus on reviewing the three final options identified by MAHC. This will help all members of the Task Force understand how the recommendation for a one-site model was made. Information regarding other models considered by MAHC may be presented at a 2 19 of 33

future meeting. Receiving this information from MAHC will facilitate opportunities to explore additional possibilities that will serve the residents of Muskoka in the future. Any questions regarding the Muskoka Algonquin Healthcare Capital Planning Task Force, or this communication, can be directed to Leanne Vincent, Corporate Coordinator, NSM LHIN at leanne.vincent@lhins.on.ca or at 705 326 7750 ext. 216. 3 20 of 33

Muskoka Algonquin Healthcare Capital Planning Task Force Communiqué December 8, 2015 The fourth meeting of the Muskoka Algonquin Healthcare Capital Planning Task Force was held on December 8, 2015 with the objectives of the meeting being to: Review options considered by Muskoka Algonquin Healthcare for future delivery of acute care services in Muskoka. The Task Force had a detailed discussion on the models considered for future acute care service delivery. A presentation was led by Muskoka Algonquin Healthcare that provided background and context on the work completed in development of their Master Plan Master Program. It was explained that the precapital submission is the first stage in the capital planning process and focuses on program and services. Stage 1 of the capital planning process includes siting of locations, local share, and the repurposing of existing facilities. It was explained that all hospitals are required to develop a Master Plan Master Program. MAHC took the task force through the 2 and a half year process that resulted in the decision by the sub committee and the Board to recommend the one site model, centrally located. Critical issues in favour of the one site model included the following; 1. Allowed the provision of the highest quality of service of all the models. A characteristic repeatedly raised by the physician group at MAHC. 2. Had the lowest estimated cost in terms of initial capital cost and local share. 3. Had the lowest estimated annual operating cost, being approximately $7million less than the lowest of the other options, giving this option the greatest chance of sustainability. Any questions regarding the Muskoka Algonquin Healthcare Capital Planning Task Force, or this communication, can be directed to Leanne Vincent, Corporate Coordinator, NSM LHIN at leanne.vincent@lhins.on.ca or at 705 326 7750 ext. 216. 21 of 33

Joint Report to Town Council Mayor G. Smith, Town of Bracebridge Mayor S. Aitchison, Town of Huntsville Appendix D NSM LHIN Healthcare Task Force Meeting - Summary Notes Page 9. 22 of 33

210 Memorial Avenue, Suite 128 Orillia, ON L3V 7V1 Tel: 705 326-7750 Fax: 705 326-1392 Toll Free: 1 866 903-5446 www.nsmlhin.on.ca 210, avenue Memorial,bureau 128 Orillia, ON L3V 7V1 Téléphone : 705 326-7750 Sans frais : 1 866 903-5446 Télécopieur : 705 326-1392 www.nsmlhin.on.ca Healthcare Task Force Meeting Summary Date: Tuesday, November 10, 2015 Time: 1:30 4:30 pm Place: District of Muskoka, 70 Pine St., Bracebridge Council Chambers Meeting Chair: Robert Morton Members: Robert Morton Chair, NSM LHIN Jill Tettmann CEO, NSM LHIN Charles Forret Chair, MAHC Phil Matthews Chair, Strategic Planning Committee, MAHC Natalie Bubela CEO, MAHC *Tim Smith in attendance for Natalie Bubela Harold Featherston Chief Executive Diagnostics, Ambulatory, Planning, MAHC John Klink District Chair, District of Muskoka Michael Duben CAO, District of Muskoka *Rick Williams in attendance for District of Muskoka Scott Aitchison Mayor, Town of Huntsville Denise Corry CAO, Town of Huntsville Graydon Smith Mayor, Town of Bracebridge John Sisson CAO, Town of Bracebridge Resources: Leanne Vincent Corporate Coordinator, NSM LHIN Additional Hospital Retention Working Group Town of Rob Alexander Attendees: Huntsville Tom Pinckard Hospital Retention Working Group Town of Huntsville Objectives 1. Clarify expectations and purpose of the Task Force 2. Establish guidelines of engagement and fundamentals of dialogue 23 of 33

Welcome and Introductions Robert Morton welcomed all attendees to the initial meeting of the Task Force. In his introductory remarks Morton informed the group that he has been meeting with Mayors from the municipalities served by Muskoka Algonquin Healthcare and noted that membership on the task force will be discussed during the meeting. Review Meeting Objectives The objectives of the initial meeting were to clarify expectations and establish guidelines of engagement and fundamentals of dialogue. These objectives are to lay the groundwork for future meetings of the Task Force. Guidelines of Engagement Jill Tettmann explained the fundamentals of dialogue practices that are utilized by the NSM LHIN noting that the documents distributed with the meeting package are meant to guide respectful conversation and dialogue. There were no objections noted to the guidelines of engagement as presented. Review Project Overview Robert Morton introduced the project overview that was distributed with the meeting package. There were no objections noted to the project overview as presented. Review Terms of Reference Robert Morton opened the conversation by stating that the terms of reference for the group identified individuals that absolutely must be included in the membership and noted that additional suggestions for membership have been identified. The Task Force engaged in a fulsome discussion around membership for the following: - East Parry Sound municipalities with MAHC as their primary catchment area - Other municipalities in Muskoka - Physicians - District of Muskoka -Other community members The discussion centered around ensuring that the Task Force has the ability to draw on resources as required to offer their perspective, guidance, and expertise. It was agreed that membership be extended to include a Mayor representing East Parry Sound as well as one Mayor from the municipalities of Gravenhurst, Lake of Bays, or Muskoka Lakes. There was discussion on members appointing delegates to attend the Task Force meetings. It was 2 24 of 33

supported that delegates be permitted, and that it be the responsibility of the member to ensure that their delegate has the required information prior to the meeting. The Task Force discussed the importance of understanding the direction of broader health service delivery in the future. A discussion ensued around voting, and the number of votes that were available. After much discussion the group recognized that we are striving to reach consensus, and that unless consensus is reached we have not truly reached a position of support to move forward. A discussion was had by the group on transparency, and if the meetings would be open meetings. The group concurred that these meetings would be treated as open meetings, with the option to move in camera based on the agenda and the topics for discussion. It was proposed that the NSM LHIN take the responsibility to complete a communique summarizing the meetings of the Task Force and that the communique become the message of the Task Force moving the process forward. A commitment was made that the LHIN would distribute a draft communique to all members within 24 hours of a meeting for review prior to broader distribution. There were no noted objections to this approach. Debrief An opportunity was provided for all members to debrief on the discussion. The comments centered around looking at the broader health system, finding a win-win solution for all, a need for support from all, finding common ground, willingness to have a conversation that dreams big and is solution based, we can t walk away from this without all parties in agreement. There was agreement to continue to invest in the Task Force by all members to move this important project forward. Development of Key Messages The key messages to summarize the initial meeting of the Task Force include that we have confirmed our task and timeframe, reviewed the Terms of Reference including membership, committed to focusing on all residents of Muskoka and East Parry Sound, and expressed a strong desire to work together. Wrap Up and Next Steps The meeting was concluded by a statement of the Chair that, We can turn this into something more than just keeping a process moving. We could accelerate our process. We may be able to really do this right and get us to a different place. 3 25 of 33

210 Memorial Avenue, Suite 128 Orillia, ON L3V 7V1 Tel: 705 326-7750 Fax: 705 326-1392 Toll Free: 1 866 903-5446 www.nsmlhin.on.ca 210, avenue Memorial,bureau 128 Orillia, ON L3V 7V1 Téléphone : 705 326-7750 Sans frais : 1 866 903-5446 Télécopieur : 705 326-1392 www.nsmlhin.on.ca Healthcare Task Force Meeting Summary Date: Monday, November 16, 2015 Time: 9:00 am 12:00 pm Place: District of Muskoka, 70 Pine St., Bracebridge Pine Room Meeting Chair: Robert Morton Members: Robert Morton Chair, NSM LHIN Jill Tettmann CEO, NSM LHIN Charles Forret Chair, MAHC Phil Matthews Chair, Strategic Planning Committee, MAHC Natalie Bubela CEO, MAHC Harold Featherston Chief Executive Diagnostics, Ambulatory, Planning, MAHC John Klink District Chair, District of Muskoka CAO, District of Muskoka Michael Duben Commissioner, Community Services, District of Rick Williams Muskoka Scott Aitchison Mayor, Town of Huntsville Denise Corry CAO, Town of Huntsville Graydon Smith Mayor, Town of Bracebridge John Sisson CAO, Town of Bracebridge Bob Young Mayor, Township of Lake of Bays Cathy Still Reeve, Village of Burk s Falls Resources: Leanne Vincent Corporate Coordinator, NSM LHIN Dr. Rebecca Van Iersel Physician Lead, NSM LHIN Dr. Correia Physician, MAHC Additional Attendees: Paula Heinemann Rob Alexander Tom Pinckard Qualified Mediator, NSM LHIN Hospital Retention Working Group Town of Huntsville Hospital Retention Working Group Town of Huntsville 26 of 33

Objectives 1. Understand initiative impacting broader health care service delivery 2. Establish planning principles for healthcare service delivery Welcome and Introductions Robert Morton welcomed all attendees and introduced Bob Young and Cathy Still as members of the Task Force. Review Meeting Objectives The objectives of the meeting were reviewed. It was asked that the meeting summary of November 10 be updated to include a notation on physicians being invited to the Task Force meetings to act as resources. Approve Terms of Reference The Terms of Reference were updated based on discussion at the November 10 meeting. An updated Terms of Reference was distributed to all members in advance of the meeting for approval. There were no objections noted to the Terms of Reference as presented. Understanding Future Health Care Service Delivery Jill Tettmann provided an overview of Health Links, noting that Health Links was introduced by the Ministry of Health and Long-Term Care aimed to focus on a small number of individuals who utilize a large amount of health care resources. Health Links was derived to bring providers together to coordinate care by creating individualized coordinated care plans. What has been found is that these patients needs often fall outside of health care and are impacted by broader social determinants of health. Rick Williams provided an update on the work of the Muskoka Health Link and on primary care in Muskoka noting the recent introduction of Health Hubs. It was noted that the Muskoka Health Link includes representation from major stakeholders in health care delivery and that there have been discussions on system level integration. Identification of service availability in Muskoka is underway and will assist in determining issues related to access. Jill Tettmann provided an update on the other Health Links in North Simcoe Muskoka noting that all Health Links are working on developing coordinated care plans and that the primary focus in on understanding the top 1-5% of high users of the health care system. A discussion on potential cost savings for the health care system through the development of Health Links ensued. An overview was provided on funding. 2 27 of 33

Primary care reform was discussed noting that primary care is the foundation of the system. Access to primary care was noted as a challenge although there is a high attachment rate. Home and community care services delivered through Community Care Access Centres was discussed. Robert Morton provided an overview of how the current home care system was established. Coordination of care was discussed as an opportunity for improvement to the health care system. Jill Tettmann provided an update on long term care redevelopment. It was noted that there are two homes in Muskoka for redevelopment. The LHIN will provide input into where beds will be redistributed and it was noted that there are no new licenses being issued for long term care beds across the province. Impacts of Future Health Care Service Delivery on Acute Care An overview was provided on how changes to health care service delivery will impact acute care. It was noted that the hospital is facing financial pressures and that the broad array of current services are at risk of sustainability over the next five to ten years. Currently 50% of emergency department visits are low acuity and planning assumed a reduction of 50%. There are a number of services currently provided in acute care that are moving to community providers. Technology was noted as having an impact of health care service delivery in the future. Debrief An opportunity was provided for all members to debrief on the discussion. The comments centered around looking for creative solutions, needing a better understanding of health care related funding in Muskoka and a need for sustainability. Public communication was noted as an area that the Task Force should focus on moving forward. A presentation from the municipalities was requested to further understand the relationship of the health care system with the municipal system. Development of Key Messages The key messages to summarize the meeting include that we have spent time to understand the future health care system and how services will be delivered and that The Task Force will need to determine a communication strategy moving forward. Wrap Up and Next Steps The next meeting will focus on the development of planning principles, as this item was deferred. 3 28 of 33

210 Memorial Avenue, Suite 128 Orillia, ON L3V 7V1 Tel: 705 326-7750 Fax: 705 326-1392 Toll Free: 1 866 903-5446 www.nsmlhin.on.ca 210, avenue Memorial,bureau 128 Orillia, ON L3V 7V1 Téléphone : 705 326-7750 Sans frais : 1 866 903-5446 Télécopieur : 705 326-1392 www.nsmlhin.on.ca Healthcare Task Force Meeting Summary Date: Wednesday, December 2, 2015 Time: 1:00 pm 4:00 pm Place: District of Muskoka, 70 Pine St., Bracebridge Pine Room Meeting Chair: Robert Morton Members: Robert Morton Chair, NSM LHIN Jill Tettmann CEO, NSM LHIN Charles Forret Chair, MAHC Phil Matthews Chair, Strategic Planning Committee, MAHC *Evelyn Brown in attendance for Phil Matthews Natalie Bubela CEO, MAHC Harold Featherston Chief Executive Diagnostics, Ambulatory, Planning, MAHC John Klinck District Chair, District of Muskoka *regrets for the meeting of December 2, 2015 Michael Duben Rick Williams CAO, District of Muskoka Commissioner, Community Services, District of Muskoka *Cheryl Faber in attendance for Rick Williams Scott Aitchison Mayor, Town of Huntsville Denise Corry CAO, Town of Huntsville Graydon Smith Mayor, Town of Bracebridge John Sisson CAO, Town of Bracebridge Bob Young Mayor, Township of Lake of Bays Cathy Still Reeve, Village of Burk s Falls Resources: Leanne Vincent Corporate Coordinator, NSM LHIN Dr. Biagio Iannantuono Physician, MAHC Dr. Correia Physician, MAHC 29 of 33