North Simcoe Muskoka Integrated Health Service Plan 1

North Simcoe Muskoka Integrated Health Service Plan 1

2 Imagine...a better health care system

North Simcoe Muskoka Integrated Health Service Plan 1. Imagine...a better health care system 2 2. A vision for health care in Ontario 4 3 Health care today in North Simcoe Muskoka 6 4 A plan for a better health care system 11 Strategic Direction 1: Improve the health of people living in North 12 Simcoe Muskoka Strategic Direction 2: Provide people with the right care, in the right 16 place, at the right time Strategic Direction 3: Use our resources effectively to help ensure 22 a sustainable health care system 5 Improving health care in 2006-2007 28 6 Appendices 30 Appendix A: Our plan for action 31 North Simcoe Muskoka Integrated Health Service Plan 1

1 Imagine... a better health care system We will build a better health care system for North Simcoe Muskoka. Beginning in the spring of 2006, we asked people who live in North Simcoe Muskoka and the health care providers who work here to share their vision for a better health care system. They told us what works best in today s health care system and what needs to be improved. They also helped identify the most important things to fix immediately, and the action plans to do that. Based on this input, we have developed a plan to make that vision of a better health care system real. We asked people who live in North Simcoe Muskoka and the health care providers who work here to share their vision of a better health care system. North Simcoe Muskoka s Integrated Health Service Plan has three strategic directions. 1. Improve the health of residents. We will help people live healthy lives by working with others on factors that influence people s health. We will develop better ways to manage and prevent chronic diseases. That way, we can help prevent these diseases from occurring and, when they do occur, we can reduce their disabling effects. We will work to address the distinct needs of our Aboriginal communities. 2. Provide the right care, in the right place, at the right time. We will reinforce that patients are the most important part of health care. We will create a patient-friendly, integrated health care system that makes it easier for patients to find the health care provider they need. And, makes it easy for them to move from one health care provider to another when necessary. We will develop a health care system that provides people with a wider range of health care options than those that exist today. 2 Imagine...a better health care system

We will work on improving access to health care. We will identify barriers that currently limit some people from receiving the care they need. And, we will work with our communities to reduce those barriers. 3. Use our health care resources wisely. We will build a health care system that our children and grandchildren can count on to be there for them well into the future. We will deal with the challenges of getting and keeping the health care providers we need. We will plan for effective use of health care buildings, equipment and ehealth technologies. We will develop new approaches to better deliver clinical programs. We will spend our resources wisely, reducing administrative and overhead costs. The Ontario Government has given the North Simcoe Muskoka Local Health Integration Network the responsibility for local health care planning, coordinating and funding in our region. This Integrated Health Service Plan, which will be implemented within the North Simcoe Muskoka LHIN s available resources, will guide health care decision-making in our region over the next three years. The plan describes the first steps to making a better health care system real in North Simcoe Muskoka. It reflects the results of an extensive engagement with the various members of the North Simcoe Muskoka community. We thank everyone who contributed their suggestions and insights to help us develop this plan, including the staff of the North Simcoe Muskoka LHIN. You all played key roles in making things happen. Ruben Rosen Chair Jean Trimnell Chief Executive Officer North Simcoe Muskoka Integrated Health Service Plan 3

2 A vision for health care in Ontario The people of Ontario deserve a health care system they can count on to deliver high quality health services. Right now, Ontario s health care strategy focuses on achieving three priorities. 1. Reducing wait times Many people wait too long for health care services. The government s plan focuses on reducing wait times and improving access to five major service areas: cancer surgery; cardiac procedures; cataract surgery; hip and knee replacements; and MRI and CT exams. A health care system that helps people stay healthy, delivers good care to them when they are sick, and will be there for their children and grandchildren. 2. Better access to doctors, nurses and other health care providers People must have access to the health care providers they need. The government will increase the number of medical school students; increase the number of positions for medical school graduates from other countries; develop Family Health Teams; develop a plan to increase the number of nurses; and open a new school of pharmacy at the University of Waterloo. 3. Keeping Ontarians healthy Ontario s health strategy will focus on preventing illnesses by helping people make better lifestyle choices to live healthier. The Ontario government is working on a 10-year plan to build a better health care system for Ontario. The long-term goal is to improve the overall health of Ontarians and the quality of health care service they receive by: Involving local communities in making decisions about the health care system 4 Imagine...a better health care system

Improving people s health Ensuring everyone has equal access to the health care services they need Improving the quality of health services and care Creating a framework for a sustainable health care system that is the best for the community What this means for our communities The Ministry of Health and Long-Term Care is responsible for health care in Ontario. However, local people are best able to determine the health care needs and priorities of their communities. Therefore, the government has created 14 Local Health Integration Networks to work with the ministry, their local service providers and members of their local communities to build better health care systems that meet the needs of their specific communities. The Integrated Health Service Plan developed for North Simcoe Muskoka LHIN reflects the needs and desires of people living here and will help make Ontario s vision for our future health care system a reality in our region. North Simcoe Muskoka Integrated Health Service Plan 5

3 Health care today in North Simcoe Muskoka Over 416,000 people live in North Simcoe Muskoka. Part of Ontario s recreational heartland, ours is one of the faster growing areas of the province. Barrie, the largest city in the region, has grown by two-thirds during the last decade. Wasaga Beach has doubled in size. The Rama Mnjikaning First Nation has grown by nearly one-half. Other communities whose growth has outpaced the province as a whole include Ramara, Penetanguishene and Huntsville. Overall, North Simcoe Muskoka spans an area of 9,200 square kilometres. Our boundaries encompass the northern portion of Simcoe County, the District Municipality of Muskoka and the communities of Craigleith, Feversham, Maxwell and Badjeros in Grey County. Our communities are home to a higher proportion of people aged 65 and older, and the average age of North Simcoe Muskoka residents will continue to increase at a rate faster than the rest of the province. As part of cottage country our seasonal population levels fluctuate considerably. In Muskoka, for example, the population increases by as much as a half during the summer months. This seasonal increase places greater demand on emergency and other urgent health services and requires considerable flexibility to accommodate the expanded needs. Our region is also a popular retirement destination. That is a major reason why our communities, except Barrie, are home to a much higher proportion of people aged 65 or older. North Simcoe Muskoka also has a relatively low percentage of young adults and the proportion of people under the age of 19 is declining. If current trends continue, the average age of North Simcoe Muskoka residents will continue to increase at a rate faster than the rest of the province. As a result, the region s health care providers will likely be called upon to treat an increasing number of age-related conditions and illnesses. Of Ontario s 14 Local Health Integration Networks (LHINs), North Simcoe Muskoka has the third highest percentage of Aboriginal people. The Aboriginal population experiences higher rates of unemployment, coupled with lower rates of education and income. Aboriginal communities also face higher mortality rates and use health 6 Imagine...a better health care system

services to a greater extent than provincial and national averages. At three per cent of our population, francophones are an important part of the region. North Simcoe Muskoka has the fifth highest percentage of francophones among Ontario s LHINs. At present, we have very little information about the health of our francophone community. However, across Ontario francophones tend to be somewhat older, with more elderly women, than the general Ontario population. Generally, the lifestyle and incidence of chronic diseases among francophones are similar to the general population, with one notable exception: they have a higher rate of heart disease. Socioeconomic factors There is a strong link between social factors such as education, employment and income and an individual s health status. Based on these factors, the population of North Simcoe Muskoka is similar to or better than the province as a whole. However, there are some significant differences among the various communities in our region. For example, education levels vary greatly among our communities. About half of the people in Georgian Bay Township have not finished high school, while four out of five people in the Blue Mountains are high school graduates. Unemployment levels also vary, from as high as 29.7 percent for Christian Island to as low as 2.2 percent for Lake of Bays. Similarly, there are differences in the numbers of low-income families, from as many as 12.9 per cent of the population in Penetanguishene to as low as 3.7 per cent in Clearview. How healthy are we? Generally, people living in North Simcoe Muskoka are just as healthy as people living elsewhere in the province. We also tend to make the same use of our health care services. One exception is that hospitalization rates are higher in North Simcoe Muskoka. However, there are some significant differences within the region itself. For example, the rates of emergency room usage, hospitalization and death in Barrie and its surrounding areas are lower than the provincial average. Yet, these rates are higher than the average elsewhere in the region. It is important to understand where health care service usage rates vary, and why they vary, in order to develop a plan for delivering effective health services in North Simcoe Muskoka. More residents of North Simcoe Muskoka report having a regular medical doctor than the average for Ontario. However, fewer of them actually had contact with that doctor in the past year. Poor health practices, such as smoking, not exercising, drinking alcohol and not eating healthy, are related to increased risks of chronic diseases, death and disability. Our region has a higher percentage of people who smoke daily and people in our region tend to consume greater amounts of alcohol. Overall, our region has higher rates of chronic diseases, such as arthritis, rheumatism, diabetes and some forms of cancer, relative to the province. Chronic diseases place a high burden on the health care system and reduce the quality of life for those suffering from these conditions. The greater prevalence of chronic diseases in North Simcoe Muskoka may reflect poor health practices and the region s higher proportion of seniors. In addition, life expectancy at birth for North Simcoe Muskoka Integrated Health Service Plan 7

both males and females is lower in the region. As a popular recreational destination, it is not surprising that, compared to Ontario as a whole, people in North Simcoe Muskoka are more likely to be physically active. However, a greater number of people in the region report being limited in their activity because of long-term physical or mental conditions. North Simcoe Muskoka LHIN s health services and programs North Simcoe Muskoka has a wide range of health service providers. Last year, funding for these services in North Simcoe Muskoka totaled approximately $464 million. Acute care Hospitals in North Simcoe Muskoka provide most of the acute care services to the people who live here. However, people with complex cases increasingly need to receive care outside the region. On average, more people are admitted to hospital in North Simcoe Muskoka than is usual in Ontario. However, six per Our services and programs General hospitals Rehab and complex continuing care Mental health and addictions Long-term care Community health centres Community care access centres Community support services Elderly persons centres 5 hospitals Regional Cancer Centre under development 2 hospitals (1 public, 1 private) + designated beds in 2 general hospitals 8 community agencies + 3 hospital-based programs + 1 provincial psychiatric hospital 24 long-term care homes + 1 new home Fall 2006 1 community health centre + 2 being developed 2 community care access centres (to be 1 as of January 2007) 35 agencies 6 centres cent of the people admitted do not require acute care, and one of every six people in an acute care bed do not require that level of care. Complex continuing care Complex continuing care is referred to as the care provided in hospitals for people with long-term illness and disabilities requiring skilled nursing care and a range of services and technologies over an extended period of time. People in need of complex continuing care often have to wait for one of these beds. There are two reasons for this. First, our region has fewer complex continuing care beds for the size of our population than the rest of Ontario. Second, people admitted to a complex continuing care bed in North Simcoe Muskoka tend to stay in that bed longer before being discharged than they do elsewhere in the province. Rehabilitation Rehabilitative services help people regain their strength, mobility and independence following an illness or injury. These services may be provided by a general or specialized rehabilitation hospital, as outpatient services, in clinics, or in a person s own home. North Simcoe Muskoka does not have enough specialized rehabilitation beds to meet its 8 Imagine...a better health care system

needs. As a result there are long wait times to receive rehabilitation services. According to provincial guidelines 1, our region has fewer rehabilititation beds for the size of our population than the rest of Ontario. There is also a limited amount of non-hospital rehabilitation services available. The Community Care Access Centres in our region have limited resources to provide in-home rehabilitation services. Long-term care homes Long-term care is required by people who need 24-hour nursing care and supervision that is typically beyond what can be provided in their home, in supportive housing or in a retirement home. People wait much longer for admission to a long-term care home in North Simcoe Muskoka than they do in the rest of Ontario. A growing number of people who require long-term care must obtain it outside the region. One reason for this is that our region has fewer longterm care beds for the size of our population over age 75 than the rest of Ontario, despite the fact that we have a greater proportion of seniors. In addition, current regulations require that only 40 per cent of long-term care beds need to be available at the basic rate. The remaining 60 per cent of long-term care beds are available at the preferred rate, which many people are unable to afford. Community Care Access Centres Community Care Access Centres are provincially-funded organizations that provide information about care options in their regions. They also determine an individual s eligibility for government-funded home care services, and admission to a long-term care home. People wait much longer for admission to a long-term care home in North Simcoe Muskoka than they do in the rest of the province, and many must obtain Through Community Care Access Centres in North Simcoe Muskoka approximately 627,000 it outside the region. hours of personal support services, 269,000 nursing visits and 60,000 therapy visits were provided in 2004/2005. Even then, they did not meet all of the demand for their services because they lacked enough health care workers, funding and other resources to do more. Community health centres Community health centres are not-for-profit organizations that provide individuals, families and communities with programs for primary health and health promotion. North Simcoe Muskoka has one community health centre in Barrie. Two additional community health centres are now being planned for Midland and Collingwood. Mental health and addictions North Simcoe Muskoka s mental health and addiction system includes both inpatient hospital treatment and community programs. In keeping with Ministry of Health and Long-Term Care policy, those services are targeted to adults with serious mental illness. There are limited services available for children and youth, and for adults with mild to moderate mental illness. The funding available for mental health and addictions services per individual in North Simcoe Muskoka is less than half of what is provided for such services in Ontario as a whole. We need more inpatient beds, and a greater number of qualified mental health 1. This is a Health Services Restructuring Commission guideline. North Simcoe Muskoka Integrated Health Service Plan 9

and addictions professionals. We also need to improve the way individuals are discharged from inpatient beds, and make their transition to community and other care organizations. In addition, there is a need for more care options and a greater ability to care for special populations. Community support services Many of the community support service agencies providing specialty care and services are located in Barrie, while others such as adult day programs, seniors centres and Meals on Wheels are located throughout the region. The funding for mental health People find it difficult to obtain the community and addictions services in support services they need. Part of the reason for this is that funding for community support services in North Simcoe Muskoka is among the lowest in Ontario, according to a 2002/03 review. There aren t enough health care workers Ontario as a whole. and volunteers. And, many of the people who need these services either don t know what services are available, or lack the transportation they need to get to a service provider. North Simcoe Muskoka is less than half of what is provided in Health care professionals North Simcoe Muskoka has a strong base of health care providers and professionals, but more are needed to meet all of the needs of the community. Today, many health care organizations have positions that they cannot fill. In the summer of 2006, there were 352 openings for health care workers including positions for 279 nurses and 73 other health care professionals, such as health care aides and personal support workers. In 2004, 568 physicians were practicing in North Simcoe Muskoka. According to a study conducted by the Under-serviced Area Program, our region has 40 fewer specialists and 34 fewer family doctors than we need to meet demands for care. Information management and information technology (IM/IT) Information management technologies help improve the safety, quality and sustainability of health care by better ensuring people have the right information, at the right time and in the right place to deliver the best services. In some ways, North Simcoe Muskoka is doing well in its use of IM/IT. For example, telemedicine is used effectively within the region to connect communities with specialized consultations and diagnostic tools. On the other hand, there are many ways we could make better use of information technologies. For example, it would be easier for people to move from one health care provider to another if they all used and shared electronic medical records. Further information on health and health service delivery in North Simcoe Muskoka is available. See page 30 for a list of supporting documents. 10 Imagine...a better health care system

4 A plan for a better health care system North Simcoe Muskoka s plan to develop a better health care system was developed with input from many of our stakeholders. Our community engagement strategy was built around four phases, illustrated below. (Descriptions of each phase are available in the supporting documents, listed on page 30.) People involved in developing this plan included the staff of health service providers, physicians, consumers and other community members. They provided input through open houses, round table discussions, focus groups, surveys and workshops. North Simcoe Muskoka LHIN staff and board members also visited many health service organizations and attended Seniors Health Fairs and other community events to obtain advice and suggestions for the plan. In addition, distinct processes were followed to involve physicians and the Aboriginal community in developing the plan. North Simcoe Muskoka s Integrated Health Service Plan identifies three strategic directions to improve our health care system, each supported by goals to be implemented between April 2007 and March 2010. In addition, plans are included to better understand the health care needs of francophones, women and the frail elderly prior to identifying specific goals to address their health care needs. Descriptions of the detailed actions is provided in Appendix A. IHSP Critical Path... Phase 1 Phase 2 Phase 3 Phase 4 Understand the need Set priorities Action plans Three-year plan Identify what North Simcoe Muskoka s health care system is today Imagine what North Simcoe Muskoka s health care system will be in the future Determine what needs to be done to move today s health care system into the future A three-year plan to make a better health care system a reality North Simcoe Muskoka Integrated Health Service Plan 11

Strategic Direction 1: Improve the health of people living in North Simcoe Muskoka The Ontario Health Quality Council Report states there should be a determined effort to continuously improve the overall health of the population of Ontario. Our initial goals for improving people s health are to improve: The factors that influence people s health Chronic disease management and prevention, and The health of Aboriginal communities. Life is very stressful. We need more mental health services, counselling, psychiatry. People here work for minimum wage, but the prices are way up because this is a tourist area. You re buying no name food; you re going home and clogging up your arteries. My neighbour has had two heart attacks and he s younger than me. And, I need to drive him to his appointments in Barrie. 12 Imagine...a better health care system

Influencing factors that affect people s health Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, states the World Health Organization. Many factors influence a person s health. These include income and social status, education, employment and working conditions. Social environments and social support networks, physical environments, personal health practices and coping skills play a role. Also important are biology and genetics, gender, culture, healthy child development and access to health services. All of these factors must be addressed in order to improve the overall health of people living in North Simcoe Muskoka. Circumstances differ from one community to another, so the factors that have the greatest influence over people s health will also differ. Age is also important. North Simcoe Muskoka has a higher than average percentage of seniors and about one-quarter of them Imagine......communities that work together to help people stay healthy. lived alone in 2001. This may be important, since social support affects a person s wellbeing. Many people report that homelessness is becoming more commonplace. So is the gap in income between rich and poor. They also report that social and disability support programs do not provide enough for shelter, food and other necessities. Addressing all of these factors will require the efforts of the North Simcoe Muskoka LHIN and many other organizations. These include: the Ministries of Health Promotion, Community and Social Services, Children and Youth, and Education; the Simcoe Muskoka District Health Unit; municipalities; and other local public and private organizations. Our plan... Establish linkages to address the broader determinants of health Action steps: We will partner in the development of two new community health centres in North Simcoe Muskoka. We will also identify key partners and work with them to address and improve the factors that affect people s health. North Simcoe Muskoka Integrated Health Service Plan 13

Managing and preventing chronic diseases When diseases are found and managed early, it is often possible to prevent their progress and reduce the health complications associated with them. Examples of chronic diseases include cancer, heart failure, high blood pressure, stroke, arthritis, diabetes, asthma, bronchitis, emphysema and depression. Today, half of Canadians live with a chronic disease. One-in-five Canadians have three or more chronic diseases. At present, the health care system does not meet these people s needs even though much of the current health care spending goes towards treating these diseases. What s more, Imagine......fewer people with chronic diseases, and better care for those that have them. because our population is aging, more people are likely to develop a chronic disease. Managing and preventing chronic diseases is important in North Simcoe Muskoka. Our residents tend to be more obese, smoke and consume more alcohol than the average Ontarian. We also have a higher proportion of seniors. All of these are reasons why we have slightly higher rates of chronic diseases than the province as a whole. People living in our region report that coordinated services for people with chronic diseases are limited. They also report a lack of funding and support for preventing chronic diseases. And, people have found that diabetes care varies depending on where they live. Our plan... Improve chronic disease management and prevention Action steps: We will assess current activities and set common goals and objectives for an improved chronic disease management and prevention program. Because of the relatively high rate of diabetes in North Simcoe Muskoka, we will focus first on managing and preventing that disease. In 2008, we will implement the diabetes management and prevention program. That program will be expanded to other chronic diseases beginning in 2009. 14 Imagine...a better health care system

Improving Aboriginal health status and services LHINs are mandated to engage their Aboriginal communities in the planning and delivery of health services, and to report each year on the health status of their Aboriginal populations. Aboriginal peoples represent 2.7 per cent of the population in North Simcoe Muskoka and they face some unique health challenges. Several research studies have found that the health of Aboriginal people across the country is below the national average. Life expectancy is lower and the four leading causes of death are injury and poisoning, heart diseases, cancer and lung diseases. In addition, diabetes is rising steadily, and obesity rates are twice the national rate. Teenage smoking is higher than average (lung cancer is the most common kind of cancer among Aboriginal men). All forms of addictions occur at a higher rate than among other Canadians. Major depression is becoming increasingly common. Low birth weights are increasing, and infant death rates are higher than typically found in Canada. Imagine......a health care system that respects Aboriginal culture and helps improve Aboriginal health. The data on the health status of Aboriginals in our region is limited. However, we do know that 47 per cent of First Nations people living in Beausoleil and Rama Mnjikaning report being in excellent or very good health. Just 22 per cent of First Nations people in Ontario report the same. Our plan... Work with Aboriginal communities Action steps: We will establish an Aboriginal health secretariat/planning body to address Aboriginal health priorities. These priorities include mental health and addictions services and the integration of holistic healing practices into mainstream health care services. North Simcoe Muskoka Integrated Health Service Plan 15

Strategic Direction 2: Provide people with the right care, in the right place, at the right time A sustainable health care system must provide quality care in the most costeffective way in a timely manner. Some people have complex and continuing needs for health care or services. These include people living with mental illness and addictions, frail elderly persons, people requiring palliative (end of life) care, and adults with disabilities. People may also face systemic barriers to getting the care they need. A full range of services must be available to meet these people s changing needs. In addition, they must be able to access care and services as they need them. Groups that may have difficulty obtaining care include women, those who are deaf, deafened and hard of hearing, and sexually and gender diverse people. We must remove the barriers that prevent some people from obtaining health care in our communities. I felt totally alone. I went through a trial and error experience with my mother. We had to find things ourselves. We didn t know there were organizations that could help. 16 Imagine...a better health care system

Creating a patient-friendly, integrated health care system People enter and move through the health care system differently, depending upon their needs. For example, as their needs change, the health care provider best able to meet those needs may also change. Often, moving from one health care provider to another is extremely difficult. Each year, thousands of people in North Simcoe Muskoka go from one health care provider to another. For example, there were 35,000 hospital discharges in 2004/05. Many of these people went on to get care from community or other organizations. Others reported feeling Imagine......a health care system focused on patients, clients and their families that supports them across the entire health care system. lost and not knowing who to call or where to start in order to find a different health care provider. Many doctors also report that they are not aware of the resources available to help their patients. Poor coordination among providers complicates a person s move from one care provider to another. There are differences across the region in the way people are referred to Community Care Access Centres when they leave a hospital. People report having difficulty moving from child to adult services. There are also gaps in the services provided for people with mental health and addictions needs. Our plan... Improve navigation and transitions Action steps: We will begin addressing this issue by creating an integrated continuum of services for people with addictions and mental health needs. This will then be extended to other clinical service areas. A mental health and addictions group that includes both community and hospital providers will lead our activities. The group will implement a regional acute care bed registry and a regional on-call psychiatry service. In 2008, we will develop and implement a plan for integrating the continuum of mental health and addiction services. In 2009, we will extend our activities to other health care areas. North Simcoe Muskoka Integrated Health Service Plan 17

Improving the continuum of care People s health care needs change over their lifetime. It is important to understand these changing needs, so the health care system can deliver the right care, in the right place, at the right time. Health care services are provided by a range of providers from hospitals to communitybased, in-home services. Evidence suggests that North Simcoe Muskoka does not have the right numbers of each type of provider. For example, some of the people admitted to hospital in our region would not be admitted to hospitals elsewhere in the province. This may be because North Simcoe Muskoka does not have enough community care options to manage their conditions. Imagine......being able to get quality health care when and where you need it. People wait longer to get into a long-term care home in North Simcoe Muskoka than people in other parts of Ontario. Members of our community have told us there are not enough other options, such as supportive housing and residential hospices. Sometimes a patient is ready to leave the hospital but the required level of service (for example a long-term care bed) is not available. These patients stay in the hospital and are sometimes referred to as requiring a different or alternate level of care setting. One of the biggest concerns of people in our community is the lack of access to family doctors. In addition, people feel they wait too long for a number of health care services, and that some services either do not exist or do so only to a limited degree. Our plan... Enhance options along the continuum of care Action steps: Alternative Level of Care: We will help establish an action group to develop processes and structures to provide people with care in the setting that best meets their needs. In 2008, the group will develop plans for implementing each component, beginning later that year and extending into 2009. Residential Hospice Beds: We will identify and implement best practices for residential hospice programs. We will pilot a rural residential hospice program in Collingwood, which will later be expanded across the region. Expert Palliative Teams: We will enhance the scope of and access to expert teams for palliative care. Our activities will include establishing the partnerships for such teams (such as with Family Health Teams). The teams will get the necessary training and ongoing education to deliver quality services. 18 Imagine...a better health care system

Reducing barriers to accessing health care Not everyone has equal access to the health care services they need. Some barriers exist only for a specific group of people. Others may affect a wider range of people. Typically, those who are disadvantaged are most likely to face systemic barriers to accessing the care they need. Very little data exists regarding systemic barriers to accessing health care. The Ontario Health Quality Council suggested in its 2006 First Yearly Report that Aboriginals, rural Ontarians, the poor and women face barriers when accessing health care. Imagine......a health care system available to everyone no matter who they are or what their needs may be. People in our community report a range of barriers. These include stigma related to illnesses or lifestyle. Some people report a lack of culturally and language-appropriate care or services. Others may not have transportation to take them to a provider, or child-care during their appointments. Many people simply aren t aware of services that exist. Our plan... Identify and reduce the system barriers to accessing health care Action steps: We will host a forum to help identify the most significant barriers to accessing the health care system, and establish processes for reducing them. Beginning in 2008, we will also launch an education campaign to raise public awareness of the various visible and invisible barriers to accessing health care to help everyone to understand and reduce them. North Simcoe Muskoka Integrated Health Service Plan 19

Understanding health care needs......of francophones Local Health Integration Networks are mandated to engage their francophone communities in the planning and delivery of health services. Many francophones have difficulty accessing health care services because they are not available in French. There are few French-speaking primary care providers in North Simcoe Muskoka. Hospitals and home care agencies are often not able to provide services in French. Being able to access health care services in French helps improve the health of francophones and the speed with which the health care system can respond to their needs. As a francophone, I ve almost given up asking for services in French. Because I know the Under Ontario law, francophones are guaranteed a right to receive services from government agencies in designated services won t be there anyway. areas. Penetanguishene and the Townships of Tiny and Essa are designated areas. Beechwood Private Hospital (Penetanguishene) and North Simcoe Hospital Alliance-Penetanguishene General Hospital are both currently designated to provide French language services. In addition, a number of other agencies are also expected to implement French language services. We will work with our francophone community to identify priority francophone health care needs and develop an inventory of current French-language health care services. We will also identify areas where additional French-language health services are required....of the frail elderly North Simcoe Muskoka currently has a higher proportion of seniors than the province as a whole. In 10 years time, more than one-third of our population will be over the age of 65 14.8 per cent will be 75 or older. Evidence shows that seniors have significant health care needs. Although a lot has been done in some parts of North Simcoe Muskoka to identify the needs of the frail elderly, the region-wide priority needs are less known. Therefore, we will focus on developing a clear picture of the frail elderly and their needs. Residents report that the shortage of long-term care beds in North Simcoe Muskoka creates long waits for admission to a long-term care home. In addition, the funding formula for long-term care homes does not take into account the requirements of frail elderly people with special needs for example, people who are deaf. At the same time, existing levels of available home care are inadequate to meet the needs of frail elders who would like to remain in their own homes. 20 Imagine...a better health care system

Frail elderly people typically have limited access to specialized services. Often, their lack of transportation prevents them from accessing care and service. Where they live may also affect the services they receive, since some communities have more established specialized services than others. Finally, some frail elderly people report that they have experienced age discrimination when attempting to access care or services. We will establish a regional action group to address the needs of the frail elderly (including those of sub-groups, such as the cognitively impaired). It will undertake an inventory of the resources available to the frail elderly and identify areas were additional services are needed....of women Women currently represent just over half of the population of North Simcoe Muskoka. Because women tend to live longer than men, the proportion of females to males increases in older age groups. There are many differences between men s and women s health issues. For example, women s heart attacks have been more likely to go undiagnosed because they have different heart attack symptoms than men. Women have traditionally been more likely to be treated with pills, than to have diagnostic tests and surgery. Other women s health care needs include greater funding for sexual assault services and an improved sensitivity to appropriate care settings and providers for sexual assault survivors. Many women lack access to free or affordable birth control. In addition, an absence of child care facilities also presents a barrier for many women in accessing health care services. We will establish a regional action group in 2008 to address women s health care needs. The action group will help assess the current state of women s health issues in the region, complete an inventory of resources, and identify additional resources, programs and services that are required North Simcoe Muskoka Integrated Health Service Plan 21

Strategic Direction 3: Use our resources effectively to help ensure a sustainable health care system The financial and human resources available for health care are not unlimited and those we have today are stretched. Therefore, the key to getting more from our health care system is to make better use of our available resources. To achieve this we must: 22 Develop new approaches to delivering clinical programs Ensure we have the health care providers we need Invest in health care buildings and equipment Maximize the benefits of ehealth technologies, and Reduce administrative and overhead costs. I am worried about the health of health care workers because they are stressed to the max. How can health care workers take care of others when they aren t healthy themselves? My neighbour had the same procedure I did, only in a different hospital. Our experiences were totally different. Everyone should have the same experience regardless of where Imagine...a you better have health your surgery. care system

Developing new approaches to delivering clinical programs and services Between their limited resources and the growing demand for services, health care organizations must try to do more with the same resources. One way is by implementing regional clinical programs such as the Simcoe Muskoka Regional Cancer Centre that provide a more efficient, safer environment in which a higher level of expertise and care may be provided to patients. Imagine......health care providers treating the same health problem in a similar way. Other clinical programs may be managed on a regional basis, though not necessarily out of a single centre. In fact, we picture a time when clinical services are coordinated across all care locations community, hospital, long term care homes. Our plan... Support clinical integration through regional clinical programs and clinical support services Action steps: We will develop criteria for regional clinical programs. These will include a framework and tools to assess the risks and benefits of these programs. Beginning in 2008, the tested framework and tools will be used to begin developing regional clinical programs, which will be implemented in 2008 and 2009. North Simcoe Muskoka Integrated Health Service Plan 23

Ensuring we have the health care providers we need The people who work in health care are very important. Without them, the health care system could not meet our needs. Currently, we do not have enough health care providers. What s more, this situation will get worse when many current providers begin to retire. Because of these shortages, doctors, nurses and other health care providers are all serving a large and wide range of patients. Imagine......a health care system with the teams of doctors, nurses, staff and volunteers it needs. Family, friends and others increasingly provide care to those who need it. Volunteers who deliver Meals on Wheels, transport patients to hospital x-ray departments and more play key roles in our health care system. These groups and their needs must also be considered when developing a health human resources strategy. The best way to make sure we have the health care providers we need is through a regional health human resources strategy. This regional strategy must focus on health professionals recruitment and retention, education and training, and initiatives to ensure a healthy workforce. Our plan... Create a regional health human resources strategy Action steps: We will develop a comprehensive health human resources strategy for North Simcoe Muskoka. Planning will begin in 2007 with a forum to address North Simcoe Muskoka s health human resource needs, followed by a multi-year action plan for meeting those needs. 24 Imagine...a better health care system

Investing in health care buildings and equipment Renewing our public infrastructure such as buildings and equipment is a key priority of the Government of Ontario. It has created a ministry to manage and fund infrastructure investments. LHINs will not be primarily responsible for approving funds for health care buildings and equipment. However, they will have a role in coordinating and supporting requests for investments to sustain the future delivery of health care services. Currently, many capital projects are underway or planned for North Simcoe Muskoka. These include the expansion of the existing site of the Royal Victoria Hospital in Barrie and building the Simcoe Muskoka Regional Cancer Centre. Other projects include the expansion of Imagine......a health care system with the buildings and equipment needed for quality health care. Soldiers Memorial Hospital in Orillia and developing a 10-bed residential hospice in Barrie. There is a proposal for redeveloping Georgian Manor in Penetanguishene. In addition, Oak Ridge, the provincial maximum security mental health facility in Penetanguishene, is overdue for rebuilding. As well, a number of community support service agencies would like to co-locate at a common site, but lack the necessary capital resources to do so. Our plan... Create a regional capital investment strategy Action steps: We will work with the appropriate groups and ministries to develop a 10-year, capital infrastructure strategy for North Simcoe Muskoka. Our initial activities will include developing an inventory of the state of existing health care buildings and equipment within the region, and identifying needs for new equipment and construction. North Simcoe Muskoka Integrated Health Service Plan 25

Maximizing the benefits of ehealth technologies ehealth refers to using information and communications technologies in the health sector to ensure the right information is available at the right time and in the right place. With ehealth, people will have the information they need to make decisions about their health and health care. Health care providers will be better able to provide quality, timely services. And the North Simcoe Muskoka LHIN will have adequate information to Imagine......a health care system that only asks people for information once. monitor and report on the performance of the health system in North Simcoe Muskoka. Health care providers in North Simcoe Muskoka use many different technologies. Not all are compatible, so information cannot always be shared among providers. In addition, their information management capabilities differ. Smaller organizations are more likely not to have the time or resources to address strategic information technology issues. As a result, their efforts may be directed more to maintaining their current systems rather than implementing new ones. Our plan... Create a regional information management/information technology strategy Action steps: We will continue asessing North Simcoe Muskoka s ehealth readiness, and work to develop an ehealth plan. The plan will be implemented in 2008 and 2009. 26 Imagine...a better health care system

Reducing administrative and overhead costs Integrating non-clinical services administrative and support services creates efficiencies through bulk purchasing power, shared overheads and reduced administrative costs. Functions that could be integrated include administration and payroll, information technology, food and laundry services, and the buying of office supplies and materials. Imagine......health agencies that keep their overhead costs as low as possible. Today, many hospitals have integrated their non-clinical activities. For example, the Royal Victoria Hospital is helping lead the Central Ontario Hospital Purchasing Alliance. For a number of years, the Collingwood General and Marine Hospital has been a member, along with 19 other hospitals, in the Healthcare Materials Management Services supply chain shared service based in London, Ontario. Our plan... Support non-clinical integration Action steps: We will assess the way non-clinical services are delivered in North Simcoe Muskoka. We will also determine how non-clinical services are best integrated and identify areas where we can do so in our region. In 2007, a pilot project will integrate selected non-clinical services in the region and will be expanded to other areas in 2008. North Simcoe Muskoka Integrated Health Service Plan 27

5 Improving health care in 2006-2007 During this initial planning phase, many activities were already proceeding to help make a better health care system real in North Simcoe Muskoka. Reducing wait times Since September 2005, the median wait times for cancer surgery, cataract surgery, hip and knee replacements and MRIs have decreased significantly. (Median wait times refer to the point when 50 per cent of patients had received treatment and the other 50 per cent were still awaiting treatment.) The median wait time for cancer surgery was reduced by 38 per cent, cataract surgery dropped by 42 per cent, hip replacements by 53 per cent, knee replacements by 58 per cent and MRIs by 71 per cent. Eight new family health teams and two new community health centres will be set up in the region. These major steps will improve access to primary care for our residents. The North Simcoe Muskoka LHIN hosted a wait time planning workshop for health care leaders and clinicians in June 2006 to identify partnerships and models to further improve wait times. Quarterly meetings are being held to review progress. Building new partnerships The process used to develop North Simcoe Muskoka s Integrated Health Plan has helped to build stronger working relationships among the health care organizations in our region. These relationships are the foundation for new, coordinated and integrated approaches to meeting North Simcoe Muskoka s health care needs. Community support agencies formed a North Simcoe Muskoka Coalition of Community Support Agencies to develop ways to improve their services. Community addictions and mental health agencies across Simcoe County and Muskoka created the Addictions and Mental Health System Leadership Group in January 2006. 28 Imagine...a better health care system

The Simcoe County Palliative End-of-Life Care Network and the Muskoka East Parry Sound Hospice Palliative Care Program joined to become the Simcoe Muskoka East Parry Sound Palliative Care Network in March 2006. This network includes approximately 70 organizations that will be delivering integrated palliative care services in North Simcoe Muskoka. Other current initiatives The Ontario government s critical care strategy is being implemented in North Simcoe Muskoka. Eight new family health teams and two new community health centres are being set up in the region. These major steps will improve access to primary care for our residents. The Central Ontario Hospital Purchasing Alliance (COHPA), which involves a number of our LHIN hospitals as well as other hospitals in Ontario, is working on an Ontario Buys project through the support of the Ministry of Finance, Supply Chain Management Secretariat. Royal Victoria Hospital is leading the COHPA steering committee, which is currently focused on the development of integrated supply chain management which includes purchasing, logistics and payables. A team of hospital pharmacies in North Simcoe Muskoka is developing new ways to deliver hospital pharmacy services on a regional basis. Future initiatives In the coming months, planning will begin to achieve several important initiatives. The North Simcoe Muskoka LHIN is developing a health human resources plan for the region in partnership with the Rural Ontario Medical Program and the Northern Ontario Medical Education Centre. The plan will focus on filling vacancies for health care providers in our region. Several initiatives are underway to make sharing of health information across North Simcoe Muskoka possible. Hospitals and Community Care Access Centres are recruiting a network Chief Information Officer to lead the integration of information technology processes, and to assist with development of an implementation plan in early 2007. Continuing to engage our community Input from the North Simcoe Muskoka community was an important element in preparing our Integrated Health Service Plan. Provincial and regional communication plans are being developed to further improve our community engagement activities. We appreciate the extensive participation of the health service providers and other members of the community in the planning activities we have undertaken to date. We look forward to their continued involvement, working with us so, together, we can make it real. North Simcoe Muskoka Integrated Health Service Plan 29

6 Appendices The North Simcoe Muskoka LHIN wishes to thank those members of the community who have journeyed with us to the Integrated Health Service Plan. The details of this journey are captured in several additional documents: Appendix A: Our plan for action Details of the actions to be taken between April 2007 and March 2010 to achieve each of the goals described in the Integrated Health Service Plan are provided as an appendix to the plan. Supporting technical documents The following technical documents are available on the North Simcoe Muskoka LHIN website at www.nsmlhin.on.ca: Community Engagement Strategy: This document summarizes the strategy that the NSM LHIN used to engage the community in the development of the Integrated Health Service Plan. Current State Assessment: This document provides a detailed summary of the current state of health and health care service delivery in North Simcoe Muskoka. Aboriginal Community Engagement Report: This document provides a detailed summary of the activities and results of the Aboriginal planning process for the Integrated Health Service Plan. The Journey from the Current State Assessment to Action Plans: This document provides a detailed summary of the activities and results of the first three phases of planning for the Integrated Health Service Plan. Call to Action Symposium Summary: This document provides a detailed summary of the discussion and next steps identified through eight workshops held during the Call to Action Symposium. 30 Imagine...a better health care system

A Appendix Our plan for action Regional action groups will have important roles in achieving several of the activities outlined in this plan. Several groups in our community already focus on issues related to these actions, and in many instances they will become the regional action groups described in this plan. Some will need to expand their membership so they can fully address all parts of the plan. Where there is no existing group, a new one will be established to lead the Integrated Health Service Plan action steps. Strategic Direction 1: Improving the health status of the residents of North Simcoe Muskoka Influencing factors that affect people s health Year 1: April 2007 - March 2008 Participate in developing two new community health centres (Midland, Collingwood) Identify and partner with other organizations that address factors affecting people s health (e.g., social/welfare agencies, etc.) Establish processes for ongoing communication and shared planning among partners Year 2: April 2008 - March 2009 To be determined based on partnership opportunities identified in Year 1 Year 3: April 2009 - March 2010 To be based on work done in Year 2 Improving Aboriginal health status and services Year 1: April 2007 - March 2008 Establish an Aboriginal health planning body/secretariat Create action plans to achieve specific priorities outlined in the Aboriginal report (e.g., mental health and addictions services, holistic health, etc.) Begin implementing action priorities by Fall 2007 Year 2: April 2008 - March 2009 Continue implementing action priorities Year 3: April 2009 - March 2010 Begin evaluating outcomes of the action plans North Simcoe Muskoka Integrated Health Service Plan 31

Managing and preventing chronic diseases Managing and preventing chronic diseases Year 1: April 2007 - March 2008 Establish a regional action group Set common goals and objectives Assess the current state of chronic disease management and prevention programs and identify areas of need Develop a pilot comprehensive model for diabetes prevention and management Year 2: April 2008 - March 2009 Implement the diabetes prevention and management pilot Year 3: April 2009 - March 2010 Evaluate the pilot and identify opportunities to broaden the program across the region and/or expand it to include other chronic diseases Strategic Direction 2: Improving access to the right care, in the right place, at the right time Creating a patient-friendly integrated health care system Year 1: April 2007 - March 2008 Build a single regional mental health and addictions action group including community and hospital providers Implement the regional acute care bed registry and on-call psychiatric program Develop broad partnerships with other organizations serving people living with mental illness and/or addictions to develop programs to meet the full range of these people s needs Year 2: April 2008 - March 2009 Develop a plan for integrating the continuum of mental health and addiction services including no wrong door and peer support programs. Implement the integration plan s components Year 3: April 2009 - March 2010 Evaluate the success of the integration plan Identify opportunities to implement integrated continuums of care for people with other complex and continuing needs Improving the continuum of health care Residential hospice beds Year 1: April 2007 - March 2008 Identify and implement best practices for residential hospice programs Obtain resources to implement residential hospices Pilot a rural residential hospice program (Collingwood) Develop a standard way of reporting hospice program information Year 2: April 2008 - March 2009 Evaluate pilot and identify opportunities to expand the program to other communities in North Simcoe Muskoka Year 3: April 2009 - March 2010 Potential expansion of the program 32 Imagine...a better health care system

Improving the continuum of health care Alternate level of care Year 1: April 2007 - March 2008 Establish a regional alternate level of care action group Identify, implement and evaluate quick win strategies Identify and establish processes and structures to advance the components of the alternate level of care framework Develop a three-year alternate level of care strategy Year 2: April 2008 - March 2009 Develop action plans for each component of the strategy Implement and evaluate as many actions as feasible Year 3: April 2009 - March 2010 Continue implementing new activities until alternate level of care levels are the best in the province Expert palliative teams Year 1: April 2007 - March 2008 Establish a shared vision and common understanding of expert teams Secure resources to implement teams (including funding for physicians and spiritual coordinators) Establish partnerships with other organizations providing palliative services (i.e., Family Health Teams) Develop training and ongoing education programs for palliative care providers Year 2: April 2008 - March 2009 Implement the training and education programs Year 3: April 2009 - March 2010 Further activities to be determined based on the results of Year 1 and Year 2 activities Access to long-term care homes for severe behaviours Year 1: April 2007 - March 2008 Identify stakeholders and establish a regional action group to lead this initiative Review existing proposals for the provision of long-term care home support for people with severe behaviours and identify next steps Year 2: April 2008 - March 2009 Proceed with next steps as they are identified Year 3: April 2009 - March 2010 Continue with next steps North Simcoe Muskoka Integrated Health Service Plan 33

Reducing barriers to accessing health care Year 1: April 2007 - March 2008 Host a forum to identify and prioritize the most significant barriers to accessing health care Develop a mechanism to track progress in identifying and reducing or removing barriers to health care Establish a process for reducing or removing barriers identified as priorities Year 2: April 2008 - March 2009 Implement an education program to raise public awareness of visible and invisible barriers to health care Reduce or remove one or more significant barriers (dependent on complexity and resources required) and evaluate the effectiveness of the processes used Continue to identify emerging barriers Year 3: April 2009 - March 2010 Continue reducing or removing priority barriers and evaluating the effectiveness of the processes Continue to identify emerging barriers Understanding the health care needs of francophones Year 1: April 2007 - March 2008 Assist the French Language Action and Support Committee in completing an assessment of francophone health care needs Develop an inventory of current French language health care services and determine areas where additional services are required Identify next steps Year 2: April 2008 - March 2009 Proceed with next steps as identified Year 3: April 2009 - March 2010 Continue with next steps Understanding the health care needs of women Year 1: April 2007 - March 2008 Activities to begin in Year 2 Year 2: April 2008 - March 2009 Establish a regional action group to lead this initiative Assess the current state of women s health care in North Simcoe Muskoka Develop an inventory of women s health care resources and identify where additional resources are required Identify next steps Year 3: April 2009 - March 2010 Implement next steps as identified 34 Imagine...a better health care system

Understanding the health care needs of the frail elderly Year 1: April 2007 - March 2008 Establish a regional action group Develop an understanding of the needs of the frail elderly population Complete an inventory of resources to serve the frail elderly and determine areas where additional resources are required Identify the unique needs of sub-populations (i.e., Aboriginal, cognitive impairment) Identify next steps Year 2: April 2008 - March 2009 Proceed with next steps as identified Year 3: April 2009 - March 2010 Continue with next steps Strategic Direction 3: Promoting sustainability through the most efficient use of available resources Developing new approaches to delivering clinical programs Year 1: April 2007 - March 2008 Establish a regional action group Develop criteria for identifying and implementing regional clinical programs Develop a framework and tools for assessing the risks and benefits of regional clinical programs Create a program development guide Pilot the tools using one established program and one new program Develop a schedule for implementing regional clinical programs Year 2: April 2008 - March 2009 Evaluate the pilot project and revise framework and tools as necessary Implement two or more regional clinical programs Year 3: April 2009 - March 2010 Continue implementing regional clinical programs Ensuring we have the health care providers we need Year 1: April 2007 - March 2008 Hold a forum to address health human resource needs related to the goals set out in the Integrated Health Service Plan Prioritize health human resource needs Develop a five-year health human resources strategy for North Simcoe Muskoka Year 2: April 2008 - March 2009 Implement Year 1 of the strategy Year 3: April 2009 - March 2010 Implement Year 2 of the strategy North Simcoe Muskoka Integrated Health Service Plan 35

Investing in health care buildings and equipment Year 1: April 2007 - March 2008 Establish linkages with the relevant groups and ministries Develop an inventory of the existing health care buildings and equipment in North Simcoe Muskoka and identify current needs for investment Review current proposals for investments in buildings and equipment to ensure they are consistent with the goals set out in the Integrated Health Service Plan Develop a 10-year capital strategy for North Simcoe Muskoka Year 2: April 2008 - March 2009 Update strategy as necessary to keep it consistent with the goals set out in the updated Integrated Health Service Plan Year 3: April 2009 - March 2010 Update strategy as necessary to keep it consistent with the goals set out in the updated Integrated Health Service Plan Maximizing the benefits of ehealth technologies Year 1: April 2007 - March 2008 Assess the ehealth readiness of local health care organizations in North Simcoe Muskoka Expand local ehealth planning committees Develop an ehealth implementation plan Year 2: April 2008 - March 2009 Begin implementing the ehealth plan Year 3: April 2009 - March 2010 Continue implementing the ehealth plan Reducing administrative and overhead costs Year 1: April 2007 - March 2008 Establish an action group Assess current administrative and overhead practices Identify leading practices for reducing administrative/overhead costs Identify opportunities to integrate non-clinical integration activities including analyzing their costs and benefits Prioritize opportunities to implement non-clinical programs Year 2: April 2008 - March 2009 Design and pilot the integration of a non-clinical program Year 3: April 2009 - March 2010 Evaluate the pilot project Identify opportunities to integrate other non-clinical services/functions 36 Imagine...a better health care system

The North Simcoe Muskoka LHIN wishes to thank those members of the community who have journeyed with us to the Integrated Health Service Plan. The details of this journey are captured in several additional reports: Appendix 1: Our plan for action Details of the actions to be taken between April 2007 and March 2010 to achieve each of the goals described in the Integrated Health Service Plan are provided as an appendix to the plan. Technical Reports Technical reports are available on the North Simcoe Muskoka LHIN website at www. nshmlhin.on.ca. Technical reports on the website are: Community Engagement Strategy: This document summarizes the strategy that the NSM LHIN used to engage the community in the development of the Integrated Health Service Plan. Current State Assessment: This document provides a detailed summary of the current state of health and health care service delivery in North Simcoe Muskoka. Aboriginal Community Engagement Report: This document provides a detailed summary of the activities and results of the Aboriginal planning process for the Integrated Health Service Plan. The Journey from the Current State Assessment to Action Plans: This document provides a detailed summary of the activities and results of the first three phases of planning for the Integrated Health Service Plan Call to Action Symposium Summary: This document provides a detailed summary of the discussion and next steps identified through eight workshops held during the Call to Action Symposium. North Simcoe Muskoka Integrated Health Service Plan 37