Consultations on Modernizing Public Health and Emergency Health Services


Emergency Health Services and Public Health Modernization Stakeholder Webcast

November 18, 2019

Colleen Kiel:

Good morning. My name is Colleen Kiel and I’m the Director of Strategy and Planning in the Office of the Chief Medical Officer of Health in the Ministry of Health. Thank you for joining us today as we launch our consultations on modernizing public health and emergency health services in the province.

Over the next hour we will have some opening remarks and discussion by our panel. This will be followed by a question and answer period. There is a box on the left of your screen where you can submit a question and our team will endeavour to get to as many as possible. If you wish to submit a question in French, you may do so. We will be responding in English today.

During the webinar this morning, you will hear reference to two discussion papers. These papers will be posted on the Ministry website later today. A link will be displayed on your screens during the webinar and we will also be emailing the link out later today. You will also receive information on how to access a recording of this webcast.

Now to get us started, our Deputy Premier and Minister of Health, Christine Elliott, is joining us on the line and is going to deliver opening remarks this morning. Good morning and welcome Minister Elliott.

Deputy Premier and Minister of Health Christine Elliott:

Good morning, everyone and thank you so much for joining us for the launch of our consultation on modernizing public health and emergency health services. It’s a pleasure to join you this morning. I would like to take a moment and thank everyone here today and to acknowledge your ongoing efforts to improve our health care system and end hallway health care.

As Ontario’s Minister of Health, I am driven by a strong commitment to strengthen our province’s health care system. The people of Ontario deserve the peace of mind that the system is going to be there for them when they need it, now and into the future. That is why we need modern and responsive systems in both public health and in emergency health services.

Over the past year, we have made great progress in health care transformation. With the creation of Ontario Health, the province’s new central health agency, and the work establishing the first wave of local Ontario Health Teams (OHTs) to serve our communities, we have made great strides towards delivering on our mission for an integrated and effective health care system that is there for you when you need it.

As part of the plan to achieve this vision, we must also consider how best to deliver both emergency health services and public health. They are both core and central components to keeping our communities healthy. These services must be resilient, efficient, nimble, and modern, and they must meet the evolving health needs and priorities of Ontario families.

As we transform the system, we have an opportunity to modernize and strengthen the role of public health and emergency health services in a considered way. We heard from our municipal partners about the need for more time to talk about changes, and we heard very clearly the need to broadly consult.

The public health and emergency health services sectors are filled with dedicated and experienced professionals who are fully committed to serving the people of Ontario, but there continues to be a very clear need to modernize and update these core health services.

Today, we are releasing two discussion papers to frame our province-wide consultations; one for public health, and one for emergency health services. These papers will anchor in-person consultations with our stakeholders across Ontario in the coming weeks.

And, I’m pleased today to introduce Jim Pine. Jim is very well-known to many of you with his 40 years of public service in our municipality and he will be leading these consultations and bring his municipal expertise to the table.

Jim joins us today with Dr. David Williams, our Chief Medical Officer of Health, and Alison Blair, who is the Ministry of Health Executive Lead for Public Health Modernization and Assistant Deputy Minister of Emergency Health Services.

This is a terrific team who, I know, are all ears for your good ideas and community-based solutions. We are committed to continuing to work with you to ensure the modernization of programs and services is informed by your advice and the daily realities of your communities.

Our government is committed to building a health care system for the people of Ontario. Ontarians can rest assured that there will be a sustainable health care system for them when and where they need it. So, I’m thanking you again for joining us today and with that I will pass it over to Jim. Thank you.

Jim Pine:

Thank you, Minister. I’ve been over the past number of weeks working with the ministry on developing the consultation plan and its rollout. The ministry is resetting the discussions with municipalities, public health and emergency health services to focus on how best to improve these important issues and services for communities across Ontario.

We’ve planned this consultation to try and generate the best ideas that we can to modernize public health and emergency health services and those sectors and learn from the experience of stakeholders and their expertise.

We’re doing the consultations for public health and emergency health services at the same time because they’re both priority areas of health transformation for the ministry and have significant partnerships with, and impact to, the municipal sector.

We want to make sure that we can hear from as many stakeholders as possible. We’ll be meeting with stakeholders across the province and making discussions paper available to all to help guide those discussions. We’re taking the time to do a consultation that allows for thoughtful input and dialogue.

As I’ve said, we’re planning a broad consultation with different components. Shortly after this webcast, we’ll be releasing two discussions papers; one for public health and one for emergency health services.

The discussion papers outline key challenges in public health and emergency health services and the systems that support them. This is really the why of the consultations. The papers also pose questions about what we can do to improve and how these challenges can be addressed.

There will be in-person sessions throughout the province with public health, emergency health services, and municipal stakeholders. We will be in touch with more information about the timing and location of these sessions as we set them up.

We’ll also conduct other engagements including with Indigenous communities and organizations. As best we can, we’ll try to meet with you where you live and where you are, in meetings or in forums where you’re already planning to be.

We also hope to hear from many of you in writing. Our email address is available, and you’ll see it posted shortly, to send your ideas. And we’ll also have a survey tool to collect your responses to the discussion questions in the discussion papers. Please submit your responses to the surveys and send any questions or comments to the email address that you’ll see shortly.

Please also subscribe to the Connected Care Updates as we’ll be providing updates throughout the consultation period. And now it’s my pleasure to turn it over to Dr. Williams.

Dr. David Williams:

Thank you, Jim. We know that in our sector there’s been longstanding challenges, and we’ve known this for quite a period of time. We also know there’s great strengths in our public health sector. As a result, in having that in mind, we want to enter into a discussion and to hear from everyone at large about how we will look to modernize our public health sector, and how we deal with change.

We know that change is inevitable, it will be coming, and we want to look with you at the public health sector as it is now, and where we’d like to end up with it in ten years from now. And so how do we build a strong sector together?

We know the landscape has changed, so then why are we modernizing public health right now? A lot of changes are happening and it’s happening in a more rapid pace. We know that there are many emerging new issues happening on a national and international level that challenge public health both in its content and its ability to respond.  This is bringing new issues to our table.

We also know that the broader health system is changing, and that’s another big issue we have to deal with. How do we work with our public health system that’s undergoing change right now, dealing with our public as they engage in the health sector and become patients and work with the physicians and the physician communities in the future? So, how do we do that in a way that’s progressive and to have input from you in the field how we should undertake this?

This is not a new issue for public health. I remember me coming down as an associate with Dr. Sheela Basrur, the late Dr. Basrur, in 2005 as an associate, we knew then we would have to look at this issue.
There have been a series of reports over the last 20 years, so the need for change, the understanding and the desire for change, and the input on change is not a new issue for us in public health. The aspect is how do we go about that and how do we carry that out in a way that’s constructive, interactive, and involves input from the whole sector, because I know there are many of you out there have strong feelings and concerns and would like to have input in that regard.

As Jim mentioned, there will be a discussion paper coming out and that’s going to form as a core aspect of our discussions as we go out to hear from you of what you would like to put forward. In that, there’s some key challenges that have been put forward to us that we need to consider.

And those are such things as, we know for a long time, insufficient capacity. We know this is variable across the province, in our different, where we used to be 42, down to 37, down to 36, and shortly down to 35 local health entities.

But, how do we make sure we deal with that and have sufficient capacity at all levels so that we wouldn’t have to work with that and have to deal with variability within the province? Because the challenges are more, they’re coming more extensively, and you’re going to have to be able to respond at the local level, at the provincial level, through our Public Health Ontario agency. And how are we all going to be equipped better to deal with this in a very much rapidly changing field?

At the same time there seems to be a misalignment between our public health sector, social services, and the health system as it goes through transformation. How do we deal with that? How do we equip ourselves to not only be at the table, to inform the table, but to engage in the many different sectors that we work with both at our local level, at a regional level, as well as at a provincial level? So, we have this challenge ahead of us as well and we need your input on how we might attach and work with our services best in that alignment.

Also, there’s duplication of effort and we’ve known this in the past that sometimes we’ll do things at the provincial level, then it’s done at regional levels, and it’s done at local levels, the same thing again and again, and this leads to certain levels of inefficiencies, but in means of times and resources, how do we best allocate that to deal with the problems on a wide basis?

So, how do we avoid duplication of services and yet get the best deliverance, both at the provincial level, at the local level, to inform the public and engage them at this time? So, duplication of effort is also an important point.

Inconsistent priority setting, this has been another area that we address in the paper that’s going to be handed out later, and this is where we have variation across the province. We have known in the past, some of our best successes in dealing with priorities, is when we pull together with an approach at the local level, at the provincial level, and we do it in the same way, but not with duplication.

An example of how we worked with the tobacco issue in the past, we came together and that was one of our most successful endeavours. So, how do we ensure we have that engagement, that dialogue, in a structure that’s going to give us the best priority setting as a sector throughout the province?

Finally, there’s issues around working with our priority and important populations; our Indigenous populations, as well as our Francophone communities. We have in our Public Health Standards, both of those are emphasized as important areas to work with, as well as with other priority populations.

How do we work better with our Indigenous populations, with the various communities, with the various different sectors that we can deliver programs that are culturally sensitive, appropriate, and what they would like to have us to work with them in their regards to their local issues and challenges that they are facing as they continue to build their communities on a go-forward basis?

So, how do we engage in that? We’re going to be asking Indigenous communities as well, how do you want us to engage, how do you want us to work with you in that regard? How do you want our local entities to work with you in that regard, because your work is an important one for us as well?

And our Francophone communities, as well, we know we have rich Francophone communities throughout Ontario, we want to make sure we deliver those along with our requirements under the FLSA, as well as our Ontario Public Health Standards of how best to engage in that regards.

And, as I said before, there’s other priority populations that we’ll have to identify and work with as well, and we want to make sure we do that in a respectful way, culturally sensitive way, and also one that’s functional and also targeted and efficient to deal with those issues there. So, with that, I’m going to hand things over to Alison Blair to talk about her area, so Alison over to you.

Alison Blair:

Great. Thanks very much David, and thanks both to Dr. Williams and to Jim for their remarks and I hope that you can tell even from this webinar that what we’re doing as a team is planning to bring each of the expertise and experience that we have to how we look at public health and emergency health services modernization.

I’ve had the pleasure of working with emergency health services for the past year and a half and I’m delighted that we’ll be spending time listening to you about how best to modernize these important services.
I also want to echo what Jim said in that the desire is for a reset in these discussions, and that means that we’re open to any and all of your comments and your ideas, and it also means that there are no predetermined outcomes from these consultations.

Emergency health services is no stranger to change. It went through a significant transformation in the late 1990’s when municipal and ambulance services were transferred to municipalities. And since then, more changes have happened and have been made to improve services.

Most recently, in 2017, there were needed updates to the Ambulance Act, and then we’re really excited about the regulations that took effect as of November 1st that support new models of care for some 911 patients, either treating patients and referring them to appropriate services, or transporting them to the care that they need, not just to emergency depart, hospital emergency departments.

But I think we can all agree that challenges remain. The Auditor General, the Dispatch Working Group, the Association of Municipalities of Ontario, the Ontario Association of Paramedic Chiefs, among others, have identified challenges affecting delivery of critical emergency health services.

In this discussion paper we outline the key challenges in the EHS sector, and we pose questions about how they can be addressed. I don’t expect any of these challenges will be a surprise to you, and in many cases, I feel like I’m just echoing back the concerns that you have raised with me over the past year and a half.
I am going to go over the concerns today just as a basis of the why we feel that emergency health services needs to be modernized. The concerns include, firstly and perhaps most importantly, outdated dispatch technology.

There have certainly been calls for upgrades to the province’s ambulance communication centres to improve response time, to support improved resource allocation, and to improve patient outcomes.

Many of the technological improvements are already in progress, but what we want to hear from you is what the next phase of technologies will be that will help Ontarians get the emergency health services that they need.

You’ve also heard about long ambulance offload times and delays in transporting medically stable patients. This is an issue that we want to make sure that we’re talking about and hearing your potential solutions to these issues.

You might read in your local media about ambulances waiting outside of emergency departments while paramedics wait to transfer patients into the care of the hospital. While ambulance offload times have improved over the past several years, there’s still a concern and they contribute to hallway health care. Also, paramedics and the ambulances waiting to offload patients are then not available to the community for emergency calls.

So, as we conduct our consultations, we’ll look for promising practices that help to address ambulance offload delays to see what benefits can be shared across the province.

Another challenge that we face is lack of coordination among the partners within the emergency health system. And, despite ongoing improvement, sometimes jurisdictional issues or communications between and among ambulance communication centres, land ambulance service operators, and air ambulance, can create challenges to getting appropriate services to patients.

So, as we consult across the provinces, we’ll be listening for opportunities to improve how land ambulance services can better collaborate together, how air ambulance and land ambulance can communicate better with one another, and how ambulance communication centres can help in that regard.

We’re also looking for how, understanding how we can scale innovations that improve care can be done across the province. I’ve had a chance to see many paramedic services that are implementing innovative practices, and they’re making a real difference in their communities. So, it’s our hope that innovation at the local levels can be replicated to other regions and to other care situations across the province.

So, as part of the consultations that we’re embarking on, we’re actively seeking to hear from you, where our communities and regions have had successes in delivering health-related services or found ways to reduce barriers to care.

And, the final challenge that I’ll talk about this morning is about health equity and access to services across regions and communities. In particular, within emergency health services, access for remote and northern Indigenous communities is an ongoing issue and concern.

In the north, land access issues create pressures for both air and land ambulance services where they are primary responders to communities that are difficult to reach by road.

Changes to modernizing these services must reflect the needs of Indigenous communities and build partnerships in a meaningful and respectful way, and we look forward to engaging with you to understand how best to address these issues.

Also, in the EHS sectors, ambulance communication centres must adhere to the requirements outlined in the French Language Services Act, as well as the air ambulance services delivered by Ornge. And, through our consultations, we’re looking to learn about what improvements could be made to the provision of services in French to Francophone communities.

So that’s a summary of the key challenges that we’ll be talking about and that you’ll see in the discussion paper later today. And with that, I will turn it back to Jim.

Jim Pine:

Thanks Alison. Let me just say that I’m really excited about the upcoming discussions personally, and I’m looking forward to meeting many of you in person as we travel around the province and receiving your responses to the discussion papers as well.

I know that there are a lot of great ideas out there waiting to be heard, and we look forward  to receiving those. We’re, we’re still developing our plans for the consultation around the province, and we’ll be in touch when we finalize those things.

But we know for sure that we’ll be heading to the north and the northwest where I was born and raised and look forward to going back there as well. But we’ll be traveling around all of the regions of the province, whether it’s in the east or the southwest, or the GTHA, central, Ottawa, and those kinds of places. And we’ll be doing that over the next few months, so it’s going to be a busy period, but I think a really productive one.

You should know that we’re also planning on providing some remarks at the upcoming Rural Ontario Municipal Association Conference, or the ROMA conference in January, and that’ll give us an opportunity to touch base what we’ve heard so far, at that point.

So, we’re very excited about getting out and seeing you. We look forward to engaging in the coming weeks and I think at this time there’s an opportunity for us to try and answer any questions that you might have at this stage. So, I’m going to turn it back over to Colleen, and do we have any questions Colleen?

Colleen Kiel:

We do, thank you. So, I want to start out with one for Alison.

Alison Blair:


Colleen Kiel:

And we’ve heard this several times already, so I think it’s a good one to start off with. Is there a plan to merge public health and emergency health services?

Alison Blair:

That is the number one frequently asked question that we’ve heard so far. The answer to that question is no. As you saw today, we have different people talking about public health and emergency health services, we have two separate discussion papers, one on public health and one on emergency health services.

And as Jim was talking about, when we go around to do our in-person consultations, we will be having separate sessions to talk about emergency health services and public health.

And so the real reason, as Jim talked about earlier, that we’re doing these consultations at the same time is `cause municipalities have to live with delivering both of these, and, so, we wanted to make sure that it was done in a way that we can make work with municipalities, and, so, these will be done separately.

So, that’s the reason why we’re doing it together, it has nothing to do with merging public health and emergency health services.  But thank you for making it now the reinforced number one frequently asked question.

Colleen Kiel:

Okay, thank you, Alison. Dr. Williams, is there consideration for the role of Public Health Ontario in this process?

Dr. David Williams:

Well, that’s a very important question because right from the get-go back post-SARS, we had two reports back then, the Agency task force and the capacity review, and we created the agency at that time.

The agency is very much an important part of what I call the three-legged stool of the public health sector in Ontario, that being the field, the Public Health agency, and the ministry. And we’re looking at how do we modernize all three to work with better efficiency, streamline certain services and activities, as all three are undergoing the changes that we’re seeing in public health.

And, we all have to prepare how to equip ourselves for the next decade ahead. So, Public Health Ontario is an important part, we’re having consultation and discussions, I know with the CEO, Dr. Peter Donnelly, and we’ve been involved in that, and we continue to undertake in those discussions, and it’ll be part of our iterative process as we go forward with the discussions that Jim has alluded to around the province.

And, because we need to hear your input on that as well, because each leg of the stool is an important one, not only Public Health Ontario, but also the ministry, and how do we do our job and work with that better with the sector. So, yes, it is an important part.

Colleen Kiel:

Thank you. For Jim, and I think you spoke a little bit about it, but maybe just reiterating where and when consultations are going to be taking place and what we know so far.

Jim Pine:

That’s a question that’s also been asked quite frequently. I think our first goal to leave and to travel is to Northwestern Ontario towards the end of this month. We’re getting those meetings set up and looking forward to it.

And then, I know we’ve got a series of meetings planned that will follow along from that and we’ll have a better calendar set up, I think, as we go forward. But certainly, the next number of weeks are going to be jam packed and we’ll be giving folks as much notice in advance as we can that we’re coming to your area, so that you’ll have a chance to get ready and to be ready to participate.

And, and if I could say one more thing, and something I may have said, or should have said at the beginning, is that there are no predetermined outcomes in this consultation. That’s been made very clear to me and it’s heart warming for me as well because we really are looking for good ideas from our stakeholder groups and interested parties.

Alison Blair:

Yeah, and just to jump in if you don’t mind. What we’re planning to do also when we’re in those areas is to be piggybacking on opportunities where you are coming together anyway in groups of people, whether that’s in regional sessions where municipalities are already meeting, or that kind of thing.

And, so I think that later this month in Northwestern Ontario, is an opportunity to do that. And so, we’ll look to make sure that we meet you where you are and where you’re working so that we can get the best input from you.

Colleen Kiel:

Great, okay. Next one is for you, Alison. Will the modernization team be meeting with local unions?

Alison Blair:

With local unions.

Colleen Kiel:


Alison Blair:

it’s a good question. We certainly are committed to meeting with unions, and, so I think the question it prompts is, will it be local? We know there are several unions in the emergency health services area that we’re familiar with and that we have met with as we’ve embarked on emergency health services modernization.

Why don’t we take it back and we’ll figure out how to do that - engage the local union operations. We’ll be working with the unions that we’ve engaged with and some that we may have not engaged with already. But we’ll try and figure out how we organize that, whether that’s a regional perspective, or a local perspective. We’ll incorporate that into our plan. Good question.

Colleen Kiel:

Okay. There was a second question, I might just answer this one cause it’s a technical one. Can written submissions be submitted? So yes, in addition to the survey that’s been referenced and will be accompanying the discussion paper, if there are written submissions to be submitted, we will be accepting those at the email address which will go up at the very end of this webinar, so yes.

Alison Blair:

Yes please.

Colleen Kiel:

Yes please. Okay now the next one is for you again Alison, I think. Can, can you comment on the event announced for November 21st by Medavie?

Alison Blair:

So, my understanding of the event that is sponsored by Medavie is an Ontario Chamber of Commerce event and the Deputy Minister has been invited to speak at that. And I think that’s all I have to say about that.
Maybe I can segue into what I think is probably the underlying question, which is - does the Deputy Minister speaking at an event sponsored by Medavie have any implication in regards to the intentions around emergency health services modernization?

And I’ll take the opportunity to echo what the Minister of Health said at the Association of Municipality of Ontario Conference in August which was, there is no intention to privatize land ambulance services.
She said, the government wants to strengthen public health delivery, and nothing has changed since the Minister  answered that question in August.

Another thing I would add to that is that municipalities are responsible by law right now to deliver those services, and so that’s something that in terms of choices about how the delivery happens, that is at the municipal level. So, that’s two extra answers for your question, that’s a three for one.

Colleen Kiel:

There might be a follow-up on that one.

Alison Blair:


Colleen Kiel:

Is the ministry planning to upload paramedic services to not-for-profit organizations?

Alison Blair:

The answer is no, and that’s also because we are starting the consultation. I’m sure it feels to a lot of people like we should be at the end of something, but we really are launching the beginning of a session where Jim and David and I will be going around the province and reading a lot of submissions that you will submit to understand what the plans are.

So I think any comment about what we think the future is going to be would be premature because we haven’t heard from all of you, and that’s what we want to spend our time over the next few months doing.

Colleen Kiel:

Thank you. Next one is for Dr. Williams. What are your top issues to fix in public health?

Dr. David Williams:

Well, that’s a good question and certainly what I would like to look at, and we’ve been dealing with for over a period of time is, as I hear from the different medical officers of health and associate medical officer of health, and from board of health members, the issues that keep coming forward are one, how do we coordinate ourselves better with communication? How do we use technology better to improve the efficiency of public health?

We’ve always valued our technology and we’ve utilized it, but it is getting dated and we have to look at how to revitalize that on a go-forward basis.

At the same time, we know that in that coordination which is so critical, because what used to happen in various areas, one we were aware of, and where the public is generally aware of, and the answer in the past was no, now everybody’s aware of.

And so that need for consistency across, and for each of us to be informed, not just from the ministry’s standpoint, or the agency’s standpoint, but each health unit has to be aware of what other health units are doing, and to understand that so we’re consistent in our messaging to a public that is more and more informed all the time, and you’re on a real time basis.

So, technology, coordination, and communication are all vital issues. Added to that is the technology driving forward in our laboratory systems is a critical one because that technology is moving the pace at which we understand, we have to decipher and analyze the data faster and faster, coordinating not only with our partners within the province, but we’re also connected live time with other partners across Canada, and internationally.

So that rapidity and the consistency and quality of that data has to be moved on. How do we handle that? And finally, the health status of our citizens is becoming more and more imperative. And we have to understand how we equip our local entities or otherwise entities, provincially and with our agency, with more and more current up to date data.

As the Auditor General pointed out, that we lack on certain key areas around lifestyles, chronic diseases, and these certain aspects of identifying priority and vulnerable populations in our midst.

So these are challenges that in the past we have understood, but we’re going to have to be a lot more quantitative, a lot more decisive, and a lot more efficient in how we handle those, and to be able to then garner and target our resources and our staffing to deal with those acute issues in that to deal with issues around equity, priority populations, and crisis within there, and not just with outbreaks of diseases, but with clustering of high risk groups within the midst of our own communities.

So, how do we work with that with our municipal partners, with our other partners at the local level, the education system, with also with social services, mental health and addictions, the list goes on? So how do we equip ourselves?

So, these are priorities for me; so, it’s communication and coordination, consistency, those C’s there, I’m trying to think what I would put for health status, except for quality of data, and we need to do that better, quicker, and really in a more robust way.

So those are my priorities. I could go on and on and I won’t go on too much longer, but these are obviously very important to me. And I think I’ve heard that from the sector, from many of you, we need to improve that bar, lift that bar and do better at it in the future.

Colleen Kiel:

Thank you, Dr. Williams. Jim, are you providing more than one location for large geographic areas? And, coupled with that, there’s a question about confirming starting and ending timelines for consultations

Jim Pine:

I think what we’re trying to do is, is to see as many people as we can, as many stakeholder groups as we can, and sometimes if we can do that when we put folks in a room together, maybe that’s the most efficient way to do it.

I do know one thing, that this province is a very, very large place to travel around having done it over the course of my life. But I think we’ll look for any opportunity that is really an effective way to do it, and sometimes that will be some individual meetings, but it also will be I think an opportunity when, as I said, we can get more people in a room at the right time and the right stakeholder groups to be as efficient as we can.

We’ve got a number of months I guess to do this into early winter. As I’ve already said, we are going to be touching base with folks back at the ROMA conference towards the end of January to talk a little bit about what we’ve heard so far.

So, it’s going to be a mixed bag of individual meetings I suspect, but also some groups meetings as well to make sure that we can hear as many as we can.

Alison Blair:

Yeah. Something I’m hearing in that question which I might be totally wrong about is whether we’re going to have one northern session that everybody has to travel into, and the answer to that is no.

We’re going to make sure that we, we recognize that the northeast and the northwest, well first are really far apart, but also that there are at least a couple of places in each of those areas that we’ll be looking to visit.

Jim Pine:

Yeah and I think it’s fair to say that we’ve had lots of interest from other parts of the province, in the southwest, and in the east, and of course we need to get there as well. So, we’ll do our very, very best to make it as accessible as possible as we go forward.

Dr. David Williams:

And I would just add that we’ve had other agencies and groups that want to have input.

Dr. David Williams:

And we want to receive that through the line that Colleen has already referred to, and we want to hear that input as well; all sectors, all inputs are valuable, and we need to hear your suggestions.

Colleen Kiel:

You will see in the discussion paper a submission deadline for the survey questions of February 10, 2020. Just noting that we’ll be seeing that later today.

Over to you again, Alison. What innovations are you looking at for land ambulance? Is the goal cost effectiveness or ending hallway health care?

Alison Blair:

Hmm, I hope those aren’t mutually exclusive. I think we’re open to hearing about all the innovations that are happening in emergency health services; that could be from a very physical thing, like a drone being used which is happening in Renfrew, through to new technologies within ambulance communication centres that are for example being piloted in Niagara, and  all the approaches in between.

If we think about some of the work that’s going on in Hamilton on ways for patients to be able to wait in the emergency department, the fit to sit program, which I might be attributing to the wrong place. It’s either Hamilton, or Ottawa, or London. But I think all of those areas have innovative programs that we can learn from and that we can spread elsewhere.

I think the goal here is about improving services. Cost effectiveness is something that I think everybody has to think about in this fiscal climate, but it’s not the driver of modernization. The driver of modernization is the need for improved services.

And ending hallway health care is something that all of us within the Ministry of Health and in this sector have our eyes on because of the impact that it has on patients. So hopefully those two things aren’t mutually exclusive.

Colleen Kiel:

Thank you. This is a question I think possibly for all of you. What is the role of data and evidence in modernization?

Dr. David Williams:

Okay, because I think as I said before, it’s very critical in there. And there’s good data and there’s bad data, and it behoves us to try and make sure we start with quality data, timely data, granular enough for those discussions.

Because in Ontario, especially with our public health sector, we want to make sure we enable the local entities to engage in those discussions with the communities. And what are those communities, and communities within communities that we would hope to come to with relevant data, timely data, and one that’s granular enough that means something to them that they can engage in and have a robust discussion about what are the public health issues in the midst of our communities? Who are our vulnerable populations that as a community we would want you as a public health sector to address? To work with us, and to engage with a changing Ontario health sector which is Ontario Health, and the Ontario Health Teams.

And how do we have that dialogue with them because we’re looking at a wider partnership, and the better we can equip them with data, the better they can deliver it as well. So, data has and continues to be an ever-growing valued commodity, but the caution is - it has to be done well, it has to be done effectively, efficiently, and in such a way that is meaningful to the communities you’re hoping to engage with. So, I think data is very critical. I don’t know if Alison or Jim want to comment on that.

Jim Pine:

The only thing I would say just to add to it, Dr. Williams has said that evidence-based decision-making is something I think that always leads to the best outcomes. And so, good data, I think, helps us make good decisions. So, I look forward to doing that, to receiving that.

Alison Blair:

Absolutely. I would add just two elements of this from the emergency health services perspective. The first is that we would love to see your evidence for what works. I know some of you are in the midst of piloting new ways of doing things and we’d love to hear how it’s going and how we can quantify the improvements.

We’re really looking forward to that and we understand also that we need to be mindful of what kinds of evidence can be brought to bear on these solutions. So, while we’re absolutely open and listening to all of your ideas, we’ll also be hitting the books and seeing what’s in articles that can be relevant to the Ontario context.

The other thing that I would be remiss in not mentioning is the importance of the exchange of data between ambulance communication centers and paramedic services, and throughout the emergency health services sector to be able to enable that work. So, data is definitely top of mind for me everyday.

Dr. David Williams:

And I would just add, part of the thing is we have - what data do you feel is needed and that we should be collecting? So, we’re not the only ones who feel there’s a sense of data. We think you, and I’ve heard this, you have a sense of that, and you may feel where there’s data gaps and other ones that need to be dealt with. Please let us know because that only informs us better how to set priorities.

Colleen Kiel:

Okay. Jim, I think this one’s for you. Beyond what we’ve spoken of public health and EHS and municipal stakeholders, are you going to engage external stakeholders like hospitals for their perspective?

Jim Pine:

Well that’s a very interesting question. I guess the short answer is I’m not sure yet. I think generally the work that’s going in Ontario Health Teams is out, is beyond or outside  of what I understand the scope is at this stage. But I could turn that over to Alison if she had anything more to add to that.

Alison Blair:

Yeah, I think it, as we’re sorting out how the engagement locally will happen, as we travel from place to place, what we’re trying to understand from the people who might wind up hosting us, whether that’s a municipality in conjunction with the emergency health services and public health folks in that area, who else should be invited.

And in some cases, you’ll have strong relationship with social services, or with education, or with the hospital, and I do think Ontario Health Teams have really captured the imagination and have got a lot of great links happening.

So, I think that’s something that we can also look locally where we’re visiting to see who is important for you invite. So, we promise to get input from you as we set out where we’re going to be visiting.

Dr. David Williams:

And, Alison as you and I both know, at our tables there’s a lot of consultation going on with the hospital sector, with Ontario Health Teams.

And so, inputs that they would have, that they may say, well it came up in our discussions, something about EHS, or about public health, at the same time we may have some inputs and may say, well we’ll pass that over to the teams, and many of them are working at the health system modernization itself.

And as the Minister alluded to in her speech, this important role of the interaction between the two is critical. And so, what are those points of contact that are going to be critical and, and imperative as we have a modern sector both sides. And so, suggestions and ideas can come through various ways and we’re open to that.

Jim Pine:

And I guess on the, on the EMS side of the equation, of course the connection to hospitals is absolutely essential.

Colleen Kiel:

Not sure, I think this might be an Alison one, and we’ve heard this one a couple of times to date. Are the 2020 dates as published in the Budget still the implementation target dates?

Alison Blair:

Okay, and I think this is mostly on the public health side. I’ll echo my previous answer. We can’t talk to you about implementation dates because we don’t know what we’re implementing yet.

And that’s what the consultation is all about. We’re really looking forward to hearing from you about what those ideas are so that we can make those recommendations to government and then we’ll be able to talk about implementation, and recognizing that as we’ve just said, the next few months will be taken up with consultations. I think it’s fair to say that that April date is no longer applicable.

Colleen Kiel:

Thank you. What is the plan, this could be for all of you, what is the plan for meaningful engagement with First Nation communities?

Dr. David Williams:

As I said in my comments at the outset, the engagement is an important one. In our Public Health Standards, it’s part of our standards. And we have been endeavouring to engage with as many different First Nation and Indigenous communities, and different organizations that represent those on an active basis.

We are asking where there’s opportunities that they would like to engage with us knowing there’s a variety of different ones and each one has a perspective they would like to ask us to consider.

And part of that is that how would our public health sector, and I’ll let Alison talk about EHS in a moment, better equipped to work with each Indigenous community and with health authorities and different structures, sometimes with our federal counterparts, to deliver a more comprehensive, culturally sensitive, appropriate, and timely programs and services that will meet the needs of the various different Indigenous communities that are at different stages in their development of their community revitalization and the development of their restructuring after the residential school type experience and the trauma.

And so we’re trying to understand how best we can move alongside when we’re asked to, if we’re asked to, and how best to be equipped to help you as you go through in those processes. So, we need your input on how you would like us to be positioned to be ready to endeavour to undertake that process, when you want us to, in a way you want us to, in a sensitive manner, and knowing that you’re undertaking right now a number of different developments at this time.

So, we want to be there, we want to listen to you, and we want to know what you would have us hear from you at that time. So, let us know how best to engage you in those discussions. Whether Alison or Jim would like to comment on that as well.

Alison Blair:

I’ll just add something quickly. In the emergency health services area, there are I think two main methods where we will be engaging Indigenous and First Nations communities.

And in emergency health services, we happen to have six emergency medical services that are run by First Nation communities, and so we will be engaging with them. We’re hoping that some of the paramedic chiefs from those services are watching right now. So that’s part of it.

There are also organizations that run services that are bonded with local First Nation areas, and there are those that, across the province, provide emergency medical services to Indigenous communities.

And so, we’ll tap in through the organizations that are already there, but our plan is also to make sure that we’re engaging with the Indigenous communities who are looking to establish better access for their communities.

So I think we’ll have to do that on a dual basis and would echo that we will plan to do that within the areas that we’re visiting, and that we’re also open to other ways to engage as per David’s comment.

Colleen Kiel:

Okay, so this is a specific EMS related one Alison. With the regionalization of health services into regional hubs, what will the province do to support municipalities in the transport of medically stable patients between health care facilities?

Alison Blair:

Wow, that’s a really good question. I imagine that if you’re working with an Ontario Health Team right now, if you’re doing anything related to emergency health services, the idea of transportation comes up and we need to be thinking about the kind of transportation that needs to happen for a 911 patient who has just been in a car accident, and we need to be thinking about the transportation of medically stable patients as well.

And so, that’s an area that you’ll see in the discussion paper that’s released later today that we cover off, that we’re looking for how best do we deliver these? And that’s going to be based on your context. If you’re in a northern community, it’s going to look quite different than if you’re in an urban community in the south.

And so, we want to make sure that we’re looking at what are the best ways to approach this. Members of my team have been looking at the transportation of medically stable patients. We have a couple of pilot projects that are going on; one in the northeast of Ontario and one in the northwest.

So, we want to make sure that we’re learning from those, but I think it’s fair to say that it’s really important for these patients to continue to be transported. And for the care of patients, and to be patient-centred, we want to make sure that they get to their dialysis appointments, or to their x-ray on time, or that they are brought back to the community closer to where they live.

And we want to make that all work while making sure that we have the capacity to answer emergency 911 calls at the same time. So, that’s something we very much want to hear from you about what you think the solutions are, and we’re all ears on that.

We will, by the way, be involving obviously paramedic services in that discussion, but the plan is also to involve those organizations that provide stretcher transportation services in that discussion as well. So, I think  that’s my answer to that one Colleen.

Colleen Kiel:

Okay, thank you, sorry. Going back to, there was a previous question about hospitals, but there have been, I think, multiple questions coming in this morning about aligning with or working with the Ontario Health Teams as they get up and running.

Dr. David Williams:

I think it’s a very good question and it is, because I said we’re not the only one undergoing change, and as we have these changes brought in, the potential of Ontario Health Teams and how we, and especially in the public health sector, would want to work with that.

We knew already some of our public health entities, local agencies and health units, have put their names down as being members of OHTs. And so, I think that has great possibility, both with formal membership in the OHT, as well as strong relationships and dialogue with those teams as they come forward, because each will represent a different segment of the population.

And I think having a strong partnership with a well-equipped and effective public health service, will only but strengthen both sides, because both the OHTs and the public health sector, we deal with the public before they become patients in the hospital system.

And how do we equip them as the Auditor General was concerned, in areas of chronic disease. We need that strong partnership to say with this burgeoning amount of disease and our aging population, we need to join hands on this and work well on that.

So, all sorts of ideas you might have out there how we can best equip our sector to be working in partnership with OHTs, and we’re going to get that feedback from our discussions as I sit with our other ADMs and the sector that’s working at that modernization, how we might look at them and what they would ask us to do to come up with a stronger partnership and a platform to build forward with.

Because this is going to be, I would say, an interactive and iterative process with them for years to come as we get better and better at this in the future. But it’s important that we start off with a good platform to build on that. I don’t know if Alison you have any comments on that.

Alison Blair:

Yeah just a few. I’ve been really excited by the excitement about Ontario Health Teams and the number of organizations that have come together. And I was at a meeting with Jim just the other day where one of the municipalities was talking about her excitement to be coming to their local councils to talk about how their Public Health Units and their paramedic services were involved in the Ontario Health Team.

So, I think that momentum is really caused by a focus on the patient, and I think what we want to make sure that we’re doing as we’re looking at modernization is to not mess with any of that. We think those partnerships are really important and we want to enable them. And so that’s something that we’ll definitely keep our eye on.

I think the role of public health, because there is so much knowledge about local communities from an epidemiological perspective, from a health status perspective, I think building on that, the OHTs, I think it will be great for them to take advantage of the knowledge of the local Public Health Units on that.

And we know that paramedic services are involved in a number of ways; obviously their role in transporting patients to the emergency department, but also looking at the new models of care that we have in place.

And something that we mentioned in the discussion paper that we’re looking to hear more from you about is the role of community paramedicine as well, that this is an area that can be beneficial to Ontario Health Teams as they look to care for patients in the community and what community paramedics can be contributing to that.

So, we think that it’s definitely something we want to be contributing to, and not getting in the way of as we look at modernization.

Colleen Kiel:

Okay, great. So, I think we have time for maybe two or three more. There’s a question around will you focus, so it’s both public health and EHS, will you focus on the opioid crisis and how public health and emergency health services respond?

Dr. David Williams:

Okay obviously the opioid crisis has been one of major importance that public health and the health system has been dealing with over the last three years, and we’ve been dealing with it. I just came back from meetings with our federal and provincial territorial committees as well, and knowing that there’s differences between of the provinces and what they’ve, what has occurred in each one.

I think the thing right you realize with Ontario, we started off with the data, which we said was important from the get go, and we made sure we put forward what was called a tracker, and was working with Public Health Ontario to make sure that each of the local health entities were equipped with their data. Because it was apparent from the start what was happening in one part of Ontario was not the same as another part of Ontario.

And as the last three years have gone on, what was happening initially two or three years ago in one, is now not happening in theirs. And each one is evolving because when we’re dealing with our communities individuals’ who are struggling with mental health and addictions, and trying to work through those issues, and the various groups that are involved in the opioid crisis, not just those that are dealing with mental health and addictions, people who are dealing with chronic pain management, in Indigenous populations they’re dealing with their own community detoxification, and those aspects, let alone released inmates, different segments of our population are dealing with different issues and components in there.

So, while it would seem maybe just to be one homogenous problem, we have a history of problems in Ontario and we’re trying to wrestle that with our new mental health and addictions approach being developed within the Ministry of Health. And this is another step further with the investments they’re planning to undertake in that.

So, it is important, it was important, and will be important as we go forward. But the answer is what’s important for us to equip our local entities, OHTs, our local hospital sectors, our local public health entities, EHS as well, to deal with the issues that they are experiencing in their respective jurisdictions.

And with Ontario being so large, and big, and widespread, there’s no cookie cutter approach that’s going to work for everybody and everytime and every way. So, we’ll endeavour to continue to keep that going forward, but we need your input.

What is working for you, what’s not working for you, what do you think would be a better way to handle this on a go-forward basis? So those discussions, I’m looking forward to hearing as we progress. I don’t know if Alison or Jim has any comments.

Alison Blair:

That’s great.

Colleen Kiel:

So, I think this is a good question to wrap up with and I think all three of you can probably say a few words around it. What is the plan after this initial consultation and next steps?

Jim Pine:

I think after we hear, we said earlier, we’re going to be coming back and telling you what we’ve heard so far when we get to the ROMA conference.

And then I think it’ll be an opportunity to think about that and then go back and talk to folks after we’ve done that to hear what we’ve been thinking a little bit about having heard what we heard. And so, we’ll be coming back out again I guess is the short answer.

Alison Blair:

Yeah, I think in this first phase, I love the expression - all ears, that we are all ears on this one and we’re going to be focusing on listening. We want to make sure that we’re feeding back to you what we’re hearing as we’re doing that listening.

And then as we’re starting to think about what might some strategies be to address the challenges that we identify in the discussion paper, we’re going to figure out how to come back to talk to you about testing those approaches; so this is what we’re hearing, this is what we think might help, and getting your perspective on that.

We haven’t figured out exactly how we’re going to do that. It could be another webinar like we’re doing right now. It could be another opportunity for feedback. I don’t imagine that we’re going to travel the entire province again, but we will get back to you about how we’re planning to do that.

In terms of timing, we expect that that would be toward the end of our sometimes very long winters, and into early spring when we’re looking at making recommendations that we’ll hear from Jim about this.

Colleen Kiel:

Okay great. Alright so thank you to the panellists this morning, and a big thank you on behalf of our team here to everyone who’s joined us today by webinar. If your colleagues were not able to join us, I know we’ve had lots of inquiries about being able to watch it later, so we will be making a link to our recording available.

On your screens you’re going to see the email address, which is our generic email account, where you can send us submissions, comments, questions. We look forward to hearing from you. We know there are questions we didn’t get to today but please know that we will read them all and those are being considered as we move forward in the consultation that we were about to, that we have now launched.

Colleen Kiel:

We look forward to hearing from you and again, thank you very much.


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