agenda, county of oxford, council meeting, 4/11/2018 9:30:00 am, council chamber

AGENDA

COUNTY OF OXFORD

COUNCIL MEETING

WEDNESDAY, APRIL 11, 2018 9:30 A.M.

COUNCIL CHAMBER, OXFORD COUNTY ADMINISTRATION BUILDING, WOODSTOCK

MEETING #7

County of Oxford ~ eAgenda Application Version 0.3.0 Agenda Version 1, Addition to Agenda➤

1. CALL TO ORDER Time ______

2. APPROVAL OF AGENDA

Note: The motion to approve the Agenda will propose changing the order of business bybringing forward 10. Unfinished Business after 8. Consideration of Correspondence.

3. DISCLOSURES OF PECUNIARY INTEREST AND THE GENERAL NATURE THEREOF

4. ADOPTION OF COUNCIL MINUTES OF PREVIOUS MEETING

March 28 2018

5. PUBLIC MEETINGS

6. DELEGATIONS AND PRESENTATIONS

1. Dirk Boogerd, PresidentOxford County Federation of Agriculture

Re: Current Tax Ratio and the Benefits of Lowering the Farm Tax Ratio

7. CONSIDERATION OF DELEGATIONS AND PRESENTATIONS

Resolution

That the information provided in the presentation given on behalf of the Oxford CountyFederation of Agriculture, regarding the current tax ratio and the benefits of lowering thefarm tax ratio, be received.

8. CONSIDERATION OF CORRESPONDENCE

1. Township of South-West OxfordApril 4, 2018

Re: Farm Tax Ratio ScenariosSWOX - 040418

Resolution

That the correspondence from the Township of South-West Oxford, dated April 4, 2018,regarding farm tax ratio scenarios, be received as information.

COUNCIL AGENDAAPRIL 11, 2018


9. REPORTS FROM DEPARTMENTS

CORPORATE SERVICES

CS 2018-09Re: Development Charges Annual Report 2017

Recommendation

1. That County Council hereby receives Report No. CS 2018-09 titled “Development Charges Annual Report – 2017”, prepared in accordance with Section 12 of O.Reg.82/98 of the Development Charges Act, 1997, and authorizes posting the report for public information.

PUBLIC HEALTH AND EMERGENCY SERVICES

PHES 2018-08Re: Appointments to Board of Health of the Oxford Elgin St. Thomas Health Unit

Recommendation

1. That, in accordance with the Health Protection and Promotion Act, R.S.O. 1990, c. H.7, the Council of the County of Oxford hereby appoints Warden Mayberry, _________________, _________________ and _____________ to the Board of Health of the Oxford Elgin St. Thomas Health Unit, as of May 1, 2018, the date named by proclamation of the Lieutenant Governor, for the remainder of the 2014- 2018 term of Council.

PARAMEDIC SERVICES

PS 2018-01Re: Oxford County Paramedic Services Ten-Year Comprehensive Master Plan Presentation

Recommendations

1. That Report No. PS 2018-01, titled “Oxford County Paramedic Services Ten-Year Comprehensive Master Plan” be received;

2. And further, that Council endorse in principle the recommendations of the Paramedic Services Ten-Year Comprehensive Master Plan as detailed in Report PS 2018-01;

3. And further, that Council authorize staff to proceed with the implementation plan for additional Near-Term paramedic service level increases in Q4-2018 as set out in Report No. PS 2018-01;

4. And further that, Council approves the Q4-2018 implementation costs of $241,500 for service enhancements in Tillsonburg to be funded by the General Reserve;

5. And further, that further Paramedic Services enhancements as outlined in Report PS 2018-01 be presented for Council consideration as part of the 2019 Budget and Business Plan.



PUBLIC WORKS

PW 2018-06Re: Amended Blue Box Program Plan

Recommendations

1. That County Council receive Report PW-2018-06 titled “Amended Blue Box Program Plan” as information;

2. And further, that a copy of this report be circulated to Area Municipalities.

PW 2018-12Re: #CycleON: Action Plan 2.0, EBR Posting No. 013-1837

Recommendations

1. That County Council endorse the Oxford County Submission in response to EBR Posting No. 013-1837 regarding the proposed #CycleON: Action Plan 2.0 as outlined in Report No. PW 2018-12;

2. And further, that Report No. PW 2018-12 be circulated to Area Municipalities for information.

PW 2018-15Re: Northeast Woodstock Trunk Sewer Downstream Upgrades, 2018 Construction Contract

Recommendations

1. That County Council award a contract to the low bidder, Omega Contractors Inc., in the amount of $2,595,861 (excluding HST), for the Northeast Woodstock Trunk Sewer Downstream Upgrades 2018 Construction Contract;

2. And further, that Council authorize the Chief Administrative Officer and Director of Public Works to sign all documents related thereto.

PW 2018-14Re: Oxford Road 3 Emergency Repairs

Recommendations

1. That County Council receive report No PW 2018-14 titled “Oxford Road 3 Emergency Repairs” for information;

2. And further, that County Council authorize the transfer of funds from the Roads Reserves, in the amount of $42,000, to finance expenditures for emergency repairs on Oxford Road 3.



10. UNFINISHED BUSINESS

CORPORATE SERVICES

Briefing Note CS 2018-03Re: 2018 Tax Policy – Supplementary Information – Farm Tax Ratio Reduction Scenarios

Resolution

That Briefing Note CS 2018-03, titled "2018 Tax Policy – Supplementary Information –Farm Tax Ratio Reduction Scenarios", be received as information.

CS 2018-08 Deferred from the March 28, 2018 Meeting

CS 2018-08Re: 2018 Tax Policy Review

Recommendation

1. That the necessary by-laws addressing the following tax policy matters be prepared on the basis of staff direction received in response to the analysis contained in Report No. CS 2018-08, entitled “Tax Policy Review”, for Council’s consideration at the April 11, 2018 Council meeting:

a. Tax Ratios; b. Tax Rate Reductions for Prescribed Property Subclasses; c. Tax Rates for Upper Tier Purposes; d. Capping Calculation Options; e. Lower Limit for Applying Tax to New Construction Properties.

Pending Items

11. MOTIONS

12. NOTICE OF MOTIONS

13. NEW BUSINESS/ENQUIRIES/COMMENTS

14. CLOSED SESSION (Room 129)

Resolution Time ______

That Council rise and go into a Closed session for the purpose of considering Report No.PW (CS) 2018-13, regarding matters that have not been made public concerningproposed or pending acquisition or disposition of land.

Resolution Time ______

That Council rise and reconvene in Open session.



15. CONSIDERATION OF MATTERS ARISING FROM THE CLOSED SESSION

PUBLIC WORKS

PW (CS) 2018-13

16. BY-LAWS

BY-LAW NO. 6009-2018Being a By-law to confirm all actions and proceedings of the Councilof the County of Oxford at the meeting at which this By-law ispassed.

17. ADJOURNMENT Time ______

MINUTES

OF THE

COUNCIL OF THE

COUNTY OF OXFORD

County Council Chamber Woodstock March 28, 2018

MEETING #6 Oxford County Council meets in regular session this twenty-eighth day of March 2018, in the Council Chamber, County Administration Building, Woodstock. 1. CALL TO ORDER: 7:00 p.m., with Warden Mayberry in the chair. All members of Council present except Councillor Tait. Staff Present: P. M. Crockett, Chief Administrative Officer L. Beath, Director of Public Health and Emergency Services P. D. Beaton, Director of Human Services L. S. Buchner, Director of Corporate Services C. Fransen, Director of Woodingford Lodge G. K. Hough, Director of Community Planning D. Simpson, Director of Public Works A. Smith, Director of Human Resources B. J. Tabor, Clerk C. J. Senior, Deputy Clerk 2. APPROVAL OF AGENDA: RESOLUTION NO. 1: Moved by: Larry Martin Seconded by: Trevor Birtch That the Agenda be approved. DISPOSITION: Motion Carried 3. DISCLOSURES OF PECUNIARY INTEREST AND THE GENERAL NATURE THEREOF: NIL 4. ADOPTION OF COUNCIL MINUTES OF PREVIOUS MEETING: Council Minutes of March 14, 2018

March 28, 2018 RESOLUTION NO. 2: Moved by: Larry Martin Seconded by: Trevor Birtch That the Council Minutes of March 14, 2018 be adopted. DISPOSITION: Motion Carried 5. PUBLIC MEETINGS: RESOLUTION NO. 3: Moved by: Stephen Molnar Seconded by: Larry Martin That Council rise and go into a public meeting pursuant to Section 7(6) of the Building Code Act S.O. 1992, as amended, to consider renewal of Sewage System Management Agreements with the Area Municipalities under a revised fee schedule, and that the Warden chair the public meeting. DISPOSITION: Motion Carried (7:01 p.m.) 1. Renewal of On-Site Sewage System Management

Agreements with Area Municipalities – Building Code Part 8 for services related to on-site sewage systems and land control for a period of two years under a revised fee schedule

The Chair asks L. Beath, Director of Public Health and Emergency Services, to come forward to present the proposal for renewal of on-site Sewage System Management Agreements with the Area Municipalities for a period of two years under a revised fee schedule. L. Beath summarizes the renewal as is contained in Report No. PHES 2018-07. The Chair opens the meeting to questions from members of Council. There are none. The Chair asks if there are any members of the public wishing to speak. No one indicates such intent.

RESOLUTION NO. 4: Moved by: Stephen Molnar Seconded by: Larry Martin That Council adjourn the public meeting and reconvene as Oxford County Council with the Warden in the chair. DISPOSITION: Motion Carried (7:04 p.m.)

PHES 2018-07 Re: Renewal of On-Site Sewage System Management Agreements with Area Municipalities – Building Code Part 8 RESOLUTION NO. 5: Moved by: Margaret Lupton Seconded by: Don McKay That the recommendations contained in Report No. PHES 2018-07, titled “Renewal of On-Site Sewage System Management Agreements with Area Municipalities – Building Code Part 8”, be adopted. DISPOSITION: Motion Carried

March 28, 2018 Recommendations Contained in Report No. PHES 2018-07: 1. That County Council authorize the Chief Administrative Officer, and Director, Public Health & Emergency Services to execute the Sewage System Management Agreements for services related to on-site sewage systems land control between the County of Oxford and participating area municipalities for a period of two (2) years under a revised fee schedule as set out in Report No. PHES 2018-07; 2. And further, that Schedule “A” to By-law No. 4889-2007, being a by-law to impose fees and charges for services that the County of Oxford provides that are not covered through direct taxation of its ratepayers, be amended.

RESOLUTION NO. 6: Moved by: Margaret Lupton Seconded by: Don McKay That Council rise and go into a public meeting pursuant to Section 17(15) of the Planning Act, R.S.O. 1990, as amended, to consider an application for Official Plan Amendment for Application No. OP 17-02-3, and that the Warden chair the public meeting. DISPOSITION: Motion Carried (7:06 p.m.) 1. Application for Official Plan Amendment

1340828 Ontario Inc. - OP 17-02-3 to re-designate the portion of the subject lands currently designated Low Density Residential to Medium Density Residential - subject lands are legally described as Lots 113, 116, 118, Part Lots 93 - 98, 119, Plan 745 & Part 1, 41R-6025 (North Norwich), Township of Norwich, located on the north side of Main Street West, east of Centre Street in the Village of Norwich

The Chair asks G. Hough, Director of Community Planning, to come forward to present the application. G. Hough summarizes Official Plan Amendment Application OP 17-02-3 as is contained in Report No. CP 2018-78. The Chair opens the meeting to questions from members of Council. In response to a question from Councillor Molnar on the proposal to include a site specific policy for the subject lands to allow for the development of a long-term care facility, G. Hough provides clarification surrounding relevant material contained in the Report. The Chair asks if the applicant wishes to speak. No one indicates such intent. The Chair asks if there are any members of the public wishing to speak in favour of or in opposition to the application. No one indicates such intent. RESOLUTION NO. 7: Moved by: Don McKay Seconded by: Margaret Lupton That Council adjourn the public meeting and reconvene as Oxford County Council with the Warden in the chair. DISPOSITION: Motion Carried (7:13 p.m.) Warden Mayberry makes note of a written submission from the Township of Norwich, dated March 14, 2018, regarding the Application for Official Plan Amendment - OP 17-02-3 - 1340828 Ontario Inc. which was provided as an attachment to Council’s electronic Agenda.

March 28, 2018 RESOLUTION NO. 8: Moved by: Don McKay Seconded by: Margaret Lupton That the submission from the Township of Norwich regarding the Application for Official Plan Amendment - OP 17-02-3 - 1340828 Ontario Inc., be received. DISPOSITION: Motion Carried CP 2018-78 Re: Application for Official Plan Amendment OP 17-02-3 – 1340828 Ontario Inc. RESOLUTION NO. 9: Moved by: Trevor Birtch Seconded by: Larry Martin That the recommendations contained in Report No. CP 2018-78, titled “Application for Official Plan Amendment - OP 17-02-3 - 1340828 Ontario Inc.”, be adopted. DISPOSITION: Motion Carried Recommendations Contained in Report No. CP 2018-78: 1. That Oxford County Council approve application OP17-02-3, submitted by 1340828 Ontario Inc., to amend the Official Plan to re-designate the portion of the subject lands currently designated Low Density Residential to Medium Density Residential, with a site specific policy to permit a mix of single-detached, townhouse and apartment dwellings, a community centre and a long-term care facility on lands described as Lots 113, 116, 119 & Part Lots 93-98, 119, Plan 745 and Part 1 41R 6025; 2. And further, that Council approve the attached Amendment No. 217 to the County of Oxford Official Plan; 3. And further, that the necessary by-law to approve Amendment No. 217 be raised. 6. DELEGATIONS AND PRESENTATIONS: 1. Dirk Boogerd, President

Oxford County Federation of Agriculture Ben Le Fort, Senior Policy Analyst Ontario Federation of Agriculture

Re: Farm Assessments and Taxes – Additional Information Dirk Boogerd, President, Oxford County Federation of Agriculture (OCFA), and Ben Le Fort, Senior Policy Analyst, Ontario Federation of Agriculture (OFA), come forward to provide additional information on farm assessments and taxes to that which was presented at the March 14th meeting. D. Boogerd provides an introduction to the presentation and states that they are accompanied here today by farmers and Board Members of the OCFA as well as members of the CFFO as this matter affects all farmers in Oxford County. He expresses the concern of rising property tax rates for farmland. D. Boogerd explains that they are not asking for a cut in taxes but to simply be assessed their fair share of the tax burden. They believe that Council should lower the farm property tax ratio so that we can all keep growing stronger together. D. Boogerd introduces Ben Le Fort who provides his analysis of the content of Corporate Services Report No. CS 2018-08 which formed part of Council’s electronic Agenda. He states that, given the growth and development in Oxford County, this County is in the unique position to be able to lower the taxes in 2018 for both the average residential and average farm property. He asks that the County consider a farm tax ratio of 0.21 for 2018 so that both residential and farm can share in the prosperity of Oxford County.

March 28, 2018 Warden Mayberry opens the meeting to questions from Council. B. Le Fort responds to comments and questions from Councillors McKay, Molnar, Birtch, and Martin.

7. CONSIDERATION OF DELEGATIONS AND PRESENTATIONS: RESOLUTION NO. 10: Moved by: Trevor Birtch Seconded by: Larry Martin That the additional information to that presented on March 14th provided in the presentation given on behalf of the Oxford County Federation of Agriculture, regarding farm assessments and taxes, be received. DISPOSITION: Motion Carried 8. CONSIDERATION OF CORRESPONDENCE: NIL

9. REPORTS FROM DEPARTMENTS: PUBLIC HEALTH AND EMERGENCY SERVICES PHES 2018-07 Re: Renewal of On-Site Sewage System Management Agreements with Area Municipalities – Building Code Part 8 The Report was dealt with under Public Meetings. COMMUNITY PLANNING CP 2018-78 Re: Application for Official Plan Amendment OP 17-02-3 – 1340828 Ontario Inc. The Report was dealt with under Public Meetings. CORPORATE SERVICES CS 2018-08 Re: 2018 Tax Policy Review RESOLUTION NO. 11: Moved by: Trevor Birtch Seconded by: Larry Martin That the recommendation contained in Report No. CS 2018-08, titled “2018 Tax Policy Review”, be adopted. DISPOSITION: See Action of Council following Resolution No. 12

March 28, 2018 RESOLUTION NO. 12: Moved by: Don McKay Seconded by: Margaret Lupton That the Report be amended to set the Farm Tax Ratio at 0.21. DISPOSITION: A Recorded Vote is requested by Councillor McKay with the following results: Those in Favour of the Motion Those Opposed to the Motion Councillors Lupton, Mayberry, McKay, Wearn Councillors Birtch, Comiskey, Martin, Molnar, Talbot Total 4 Total 5 Resolution No. 12 is Not Carried Absent: 1 (Councillor Tait) DISPOSITION ON RESOLUTION NO. 11 WITH A FRIENDLY AMENDMENT BY THE MOVER AND SECONDER TO DEFER TO APRIL 11, 2018: Motion Carried Recommendation Contained in Report No. CS 2018-08: 1. That the necessary by-laws addressing the following tax policy matters be prepared on the basis of staff direction received in response to the analysis contained in Report No. CS 2018- 08, entitled “Tax Policy Review”, for Council’s consideration at the April 11, 2018 Council meeting: a. Tax Ratios; b. Tax Rate Reductions for Prescribed Property Subclasses; c. Tax Rates for Upper Tier Purposes; d. Capping Calculation Options; e. Lower Limit for Applying Tax to New Construction Properties. PUBLIC WORKS PW 2018-07 Re: Contract Award for County Courthouse Roof Replacement – Phase 2 RESOLUTION NO. 13: Moved by: Trevor Birtch Seconded by: Larry Martin That the recommendation contained in Report No. PW 2018-07, titled “Contract Award for County Courthouse Roof Replacement - Phase 2”, be adopted. DISPOSITION: Motion Carried Recommendation Contained in Report No. PW 2018-07: 1. That County Council authorize a transfer of $253,532 from the Facilities reserves to address the budget shortfall for the County Courthouse Roof Replacement Phase 2 contract.

March 28, 2018 PW 2018-08 Re: 2017 Annual Waste Management Reports RESOLUTION NO. 14: Moved by: Sandra Talbot Seconded by: Trevor Birtch That the recommendation contained in Report No. PW 2018-08, titled “2017 Annual Waste Management Reports”, be adopted. DISPOSITION: Motion Carried Recommendation Contained in Report No. PW 2018-08: 1. That County Council receive Report No. PW 2018-08 titled “2017 Annual Waste Management Reports” as information. PW 2018-09 Re: 2017 Annual Wastewater System Performance RESOLUTION NO. 15: Moved by: Sandra Talbot Seconded by: Trevor Birtch That the recommendations contained in Report No. PW 2018-09, titled “2017 Annual Wastewater System Performance”, be adopted. DISPOSITION: Motion Carried Recommendations Contained in Report No. PW 2018-09: 1. That County Council receive Report PW 2018-09 titled “2017 Annual Wastewater System Performance”, including the individual 2017 Annual Wastewater Treatment Plant Summary Reports; 2. And further, that County Council receive the 2017 Annual Biosolids (Non-Agricultural Source Material) Summary Report, including the performance summary of the County’s wastewater treatment plant biosolids processing, land application program and biosolids centralized storage facility (BCSF). PW 2018-10 Re: Workplace Electric Vehicle Charging Incentive Program (WEVCIP) RESOLUTION NO. 16: Moved by: Marion Wearn Seconded by: Don McKay That the recommendations contained in Report No. PW 2018-10, titled “Workplace Electric Vehicle Charging Incentive Program (WEVCIP)”, be adopted. DISPOSITION: Motion Carried

March 28, 2018 Recommendations Contained in Report No. PW 2018-10: 1. That County Council received Report No. PW 2018-10 titled “Workplace Electric Vehicle Charging Incentive Program” for information; 2. And further, that Council authorize the Chief Administrative Officer and the Director of Public Works to accept and execute all necessary documents for the Ministry of Transportation WEVCIP funding program for the six respective Electric Vehicle Service Equipment (EVSE) locations as outlined in Report PW 2018-10. PW 2018-11 Re: Trans Canada Trail Update and Proposed Trail Extension RESOLUTION NO. 17: Moved by: Marion Wearn Seconded by: Don McKay That the recommendations contained in Report No. PW 2018-11, titled “Trans Canada Trail Update and Proposed Trail Extension”, be adopted. DISPOSITION: Motion Carried Recommendations Contained in Report No. PW 2018-11: 1. That County Council receive Report No. PW 2018-11 titled “Trans Canada Trail Update and Proposed Trail Extension” as information; 2. And further, that County Council authorize a transfer of $330,000 from General Reserves to fund unspent 2017 approved TCT budget carried over into 2018 for construction of the TCT extension and remaining works; 3. And further, that County Council approve an amendment to the trail route, identified in Schedule A of the Trans Canada Trail Agreement between the County of Oxford and Town of Tillsonburg, to include an extension of the off road multi-use recreation trail, from west of Tillson Avenue to Quarter Town Line along the former Canada Southern Station (CASO) railway corridor within Tillsonburg, subject to a resolution from Town of Tillsonburg Council. 10. UNFINISHED BUSINESS: Pending Items No discussion takes place regarding the Pending Items list. 11. MOTIONS: NIL 12. NOTICE OF MOTIONS: NIL 13. NEW BUSINESS/ENQUIRIES/COMMENTS: NIL 14. CLOSED SESSION: NIL

March 28, 2018 15. CONSIDERATION OF MATTERS ARISING FROM THE CLOSED SESSION: Not Required. 16. BY-LAWS: BY-LAW NO. 6006-2018 Being a By-law to adopt Amendment Number 217 to the County of Oxford Official Plan. BY-LAW NO. 6007-2018 Being a By-law to amend By-law No. 5852-2016, a By-law establishing County Council Procedures for governing the proceedings of the Council, the conduct of its members and the calling of meetings of the County Council of the County of Oxford. BY-LAW NO. 6008-2018 Being a By-law to confirm all actions and proceedings of the Council of the County of Oxford at the meeting at which this By-law is passed. RESOLUTION NO. 18: Moved by: Ted Comiskey Seconded by: Sandra Talbot That the following By-laws be now read a first and second time: No. 6006-2018, No. 6007-2018 and No. 6008-2018. DISPOSITION: Motion Carried RESOLUTION NO. 19: Moved by: Ted Comiskey Seconded by: Sandra Talbot That the following By-laws be now given third and final reading: No. 6006-2018, No. 6007-2018, and No. 6008-2018. DISPOSITION: Motion Carried 17. ADJOURNMENT: Council adjourns its proceedings until the next meeting scheduled for Wednesday, April 11, 2018 at 9:30 a.m. 8:28 p.m. Minutes adopted on by Resolution No.

WARDEN

CLERK

From: CAO Sent: April-04-18 1:51 PM To: Brenda Tabor Subject: FW: Farm Ratio Scenarios Spreadsheet - County Council Agenda Item

Good afternoon Brenda: Council discussed the attached spreadsheet yesterday at the Regular Council Meeting. It would be greatly appreciated if it could be included as part of the tax ratio discussion at the April 11th, 2018 county council meeting. Our Mayor David Mayberry is prepared to speak to it.

Facebook Twitter www.swox.org

From: Diane Larder Sent: April-03-18 11:45 AM To: CAO <[email protected]>; Ward 1 <[email protected]>; Ward 2 <[email protected]>; Ward 3 <[email protected]>; Ward 4 <[email protected]>; Ward 5 <[email protected]>; Ward 6 <[email protected]>; David Mayberry <[email protected]> Cc: Clerk <[email protected]>; CBO <[email protected]>; Bill Freeman <[email protected]>; Fire Chief <[email protected]> Subject: FW: Farm Ratio Scenarios Spreadsheet

Diane

https://www.facebook.com/The-Township-of-South-West-Oxford-258936727626392/

https://twitter.com/SWOX123

www.swox.org

mailto:[email protected]












Levy Distribution - Scenarios - Farm Ratio 0.235 and 0.21 Compared to 0.25

2015 2016 2017 2018 2018 2018

Farm Ratio 0.25 0.25 0.25 0.25 0.235 0.21

Residential $33,625,417 $34,178,985 $35,558,014 $36,041,166 $36,214,868 $36,505,925

Farm 2,957,395 3,181,470 3,927,535 4,460,818 4,212,109 3,795,398

Commercial 6,985,388 7,041,814 7,114,414 7,195,675 7,230,366 7,288,480

Industrial 2,048,438 1,850,487 2,029,507 2,046,774 2,056,640 2,073,169

Large Industrial 3,541,461 3,817,124 3,611,233 3,535,378 3,552,419 3,580,969

TAXABLE TOTAL $49,158,099 $50,069,880 $52,240,703 $53,279,811 $53,266,402 $53,243,941

Change in Farm Portion from 2015 $224,075 $970,140 $1,503,423 $1,254,714 $838,003

2018 2018 2018

Farm Ratio 0.25 0.235 0.21

Residential 7.2% 7.7% 8.6%

Farm 50.8% 42.4% 28.3%

Commercial 3.0% 3.5% 4.3%

Industrial -0.1% 0.4% 1.2%

Large Industrial -0.2% 0.3% 1.1%

Property Tax Class

Property Tax ClassMunicipal General Levy

% Increase (2015 as Base Year)

Report No: CS 2018-09

CORPORATE SERVICES Council Date: April 11, 2018

To: Warden and Members of County Council

From: Director of Corporate Services Development Charges Annual Report - 2017 RECOMMENDATION 1. That County Council hereby receives Report No. CS 2018-09 titled “Development

Charges Annual Report – 2017”, prepared in accordance with Section 12 of O.Reg.82/98 of the Development Charges Act, 1997, and authorizes posting the report for public information.

REPORT HIGHLIGHTS Total development charges collected amounted to $7,066,791 ($7,003,994 – 2016)

Accrued interest earned by the development charges accounts was $166,207 ($118,983 – 2016)

Total development charges funds used for capital projects was $4,988,154 ($4,894,730 – 2016)

Implementation Points In order to satisfy subsection 43.(2.1) of the Development Charges Act, 1997, following adoption of the recommendation contained in this report, the Treasurer will make the report available to the public by posting it to the County website.

Financial Impact Growth related capital projects have been funded using development charges revenues based on actual expenditures in 2017 in accordance with projects identified in the current Development Charges Background Study. The Treasurer has reviewed this report and confirms that the County is in compliance with subsection 59.1(1) of the Development Charges Act, 19971.

1 Subsection 59.1(1) A municipality shall not impose, directly or indirectly, a charge related to a development or a requirement to construct a service related to development, except as permitted by this Act or another Act. 2015, c.26, s.8

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Risks/Implications There are no risks or implications that will result by adopting the recommendation contained within this report. Strategic Plan (2015-2018) County Council adopted the County of Oxford Strategic Plan (2015-2018) at its regular meeting held May 27, 2015. The initiative contained within this report supports the Values and Strategic Directions as set out in the Strategic Plan as it pertains to the following Strategic Directions: 3. iii. A County that Thinks Ahead and Wisely Shapes the Future - Demonstrated commitment to

sustainability by:

- Ensuring that all significant decisions are informed by assessing all options with regard to the community, economic and environmental implications including:

o Life cycle costs and benefit/costs, including debt, tax and reserve levels and implications

4. ii. A County that Informs and Engages - Inform the public about County programs, services and activities through planned communication that includes:

- A County Report Card that engages and informs our community and celebrates our successes and our history

DISCUSSION Background In accordance with Section 12 of O.Reg.82/98, of the Development Charges Act, 1997, the Treasurer of the municipality shall provide to Council a financial statement relating to the reserve funds established under a by-law to collect development charges. The statement provided by the Treasurer is required to be made available to the public and to the Minister of Municipal Affairs and Housing on request. Attachment No. 1 provides the following information prescribed in Section 12 of O.Reg.82/98 as information to be included in the statement of the treasurer of a municipality under section 43 of the Act: Description of the Service – service for which the fund was established. Opening Balance – balance of the reserve fund at the beginning of the year. Collections – funds received from property owners/developers usually at the date that a

building permit is issued. Accrued Interest – interest earned on the fund balance. Repayment of Borrowed Funds, Including Interest – receipt of principal and interest of

funds previously loaned. Transferred to Capital or Other Funds – funds taken from the reserve funds to meet

growth-related net capital costs for which the development charge was imposed. Amounts Refunded – if the development charge is amended by Council or by the

Municipal Board, the County shall immediately refund the difference. Amounts Loaned to other Service Category – the transfer of funds to finance another

service i.e. water, sewer, etc. – to be repaid bearing interest.

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Credits – if a property owner/developer paid all or any portion of a charge relating to

development prior to the development charge by-law coming into force, a credit is applied to offset the previous payment.

Amounts Borrowed from Fund for Other Municipal Purposes - the transfer of funds to finance another municipal service.

Closing Balance – balance of the reserve fund at the end of the year. Other Development Charge By-law Rules

Attachment No. 2 provides project specific information prescribed in Section 12 of O.Reg.82/98 that is to be included in the statement of the treasurer of a municipality under section 43 of the Act: Capital Project Funded from Reserve Fund – the amount of money from each

development charge reserve fund used to fund the project. Capital Project Costs Funded from Other Sources – the amount and source of any other

money used to fund the project. Timing of Collection – the development charge will be collected at the time of subdivision

agreement for sewer and water services and at the time of issuance of the first building permit for all remaining services.

Indexing – automatic indexing of the development charges will be implemented on April 1 of each year, in accordance with the Statistics Canada Construction Price Statistics.

10% Reduction – capital costs must be reduced by 10% with the exception of water supply services, waste water services, storm water drainage and control services, services related to a highway and to electrical power, transit, waste diversion, police and fire protection services – the primary services that the 10% reduction applies to are parks, recreation and libraries.

Comments Development Charge Eligible Cost Analysis The nature of capital projects and timing identified when the by-law was passed reflected the intentions of the Council at that time. However, over time, municipal projects and Council priorities change and, accordingly, Council’s intentions may alter, and different capital projects (and timing) may be required to meet the need for services required by new growth. The development related capital requirements are established over a ten year planning period. By-laws passed under the Development Charges Act are required to be reviewed every five years. The County’s development charges by-law was, therefore, reviewed over the course of 2013 and 2014 resulting in the enactment of new by-laws taking effect June 25, 2014. The next five-year by-law review will commence in 2018 with the intent for updated by-laws to be considered by Council in the second quarter of 2019. Development Charges are used to finance capital works required for new housing and non-residential development. The county-wide by-laws apply to most new residential and some forms of non-residential development on lands within the boundaries of Oxford County. Development Charges generated from the county-wide charge go toward growth-related costs associated with general government, roads, land ambulance and library services. The water and wastewater by-laws apply specifically to development of lands within a geographic area defined in each by-law that generally corresponds to the jurisdiction named in the title. Development Charges generated from these by-laws go toward growth-related costs associated with the provision of water and wastewater infrastructure. All current County Development Charge by-

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laws under the authority of the Development Charges Act, (1997) came into effect on June 25, 2014. Conclusion The County schedule of Development Charges is summarized in the tables found on Attachment No. 3. The schedule sets out the charges that are applicable to residential development by unit type: single and semi-detached dwelling units; apartments; and other multiples. Charges applicable to non-residential development are levied based on square meter (or foot) of gross floor area. To determine the total County charge, add the county-wide charges to the applicable area-specific charges for water and wastewater. For areas not serviced by municipal sewer and water services, only the county-wide charge applies. The County Development Charges are indexed on April 1st of each year in accordance with the annual change in the Statistics Canada Construction Price Index. SIGNATURES Report Author: Original signed by: Carolyn King, CPA, CA Manager of Finance Departmental Approval: Original signed by: Lynn S. Buchner, CPA, CGA Director of Corporate Services Approved for submission: Original signed by:

Peter M. Crockett, P.Eng. Chief Administrative Officer ATTACHMENTS Attachment No. 1 - Development Charge Reserve Funds Statement, December 31, 2017 Attachment No. 2 – Growth-Related Projects Funding Sources, 2017 Attachment No. 3 – County Development Charges Schedule, April 1, 2018

Page 4 of 4

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Development Charge Reserve Funds StatementFor the Year Ended December 31, 2017

Fund Opening Balance Collections

Accrued Interest

Repaymt of Borrowed

Funds incl. Interest

Transferred to Capital or Other

Funds Amounts Refunded

Amounts Loaned to

other Service Category Credits

Amounts Borrowed from Fund for Other

Munic Purposes Closing Balance

Non-Discounted ServicesRoads 91230 1,413,639 1,471,175 25,158 - (1,456,810) - - - - 1,453,162 Water* 1,146,212 1,366,590 20,399 - (1,050,305) - - - - 1,482,896 Sanitary Sewer* 5,824,113 3,924,044 103,649 - (2,320,831) - - - - 7,530,975

Discounted Services Library 91600 348,485 163,220 6,202 - (78,200) - - - - 439,707 Land Ambulance 91500 94,697 93,092 1,685 - (40,000) - - - - 149,474 Facilities 91210 8,591 45,137 153 - (28,000) - - - 25,881 Administration 91100 503,517 3,533 8,961 - (14,008) - - - - 502,002

9,339,253 7,066,791 166,207 - (4,988,154) - - - - 11,584,097

Notes* see supplementary table for system specific details.

Opening Balance Collections

Accrued Interest

Repaymt of Borrowed

Funds incl. Interest

Transferred to Capital or Other

Funds Amounts Refunded

Amounts Loaned to

other Service Category Credits

Amounts Borrowed from Fund for Other

Munic Purposes Closing Balance

WaterBlandford-Blenheim 91268 86,716 - 1,543 - - - - - - 88,260 Blandford-Blenheim 91266 43,451 48,753 773 - (80,000) - - - - 12,978 EZT - Tavistock 91265 477,213 47,605 8,493 - - - - - - 533,311 Ingersoll 91263 80,295 198,314 1,429 - (157,961) - - - - 122,077 Norwich 91264 92,358 58,088 1,644 - - - - - - 152,090 Tillsonburg 91262 63,201 123,800 1,125 - (150,000) - - - - 38,126 Woodstock 91261 270,579 838,860 4,815 - (622,344) - - - - 491,910 Zorra - Thamesford 91267 32,398 51,170 577 - (40,000) - - - - 44,145

1,146,212 1,366,590 20,399 - (1,050,305) - - - - 1,482,896 Sanitary SewerBlandford-Blenheim 91258 365,280 25,065 6,501 - (22,452) - - - - 374,394 Blandford-Blenheim 91256 83,636 138,444 1,488 - (170,000) - - - - 53,568 EZT - Tavistock 91255 45,754 475,893 814 - (318,138) - - - - 204,323 Ingersoll 91253 174,860 1,172,328 3,112 - (1,207,121) - - - - 143,179 Norwich 91254 1,043,098 212,764 18,564 - - - - - - 1,274,426 Tillsonburg 91252 3,586,893 844,346 63,835 - (344,188) - - - - 4,150,885 Woodstock 91251 449,564 908,946 8,001 - (146,491) - - - - 1,220,020 Zorra - Thamesford 91257 75,028 146,257 1,335 - (112,441) - - - - 110,180

5,824,113 3,924,044 103,649 - (2,320,831) - - - - 7,530,975

6,970,325 5,290,634 124,048 - (3,371,136) - - - - 9,013,870

Report No. CS 2018-09 Attachment No. 1

Growth-Related Projects Funding SourcesFor the Year Ended December 31, 2017

W/WWYTD UNFINANCED TOTAL RATES & DEVELOPMENT OTHER

DESCRIPTION EXPENDITURES CAPITAL TAXATION ** RESERVES ** RESERVES ** CHARGES SOURCES*ROADS

930004 CR 4 3,194 - 3,194 - - - 3,194 -930000 TRANSPORTATION MASTER PLAN UPDATES 139,176 - 139,176 - - 69,588 69,588 -930012 CR 12 62,842 - 62,842 1,975,000 - (1,943,579) 31,421 -930020 CR 20 1,748,151 (497,415) 2 1,250,736 865,000 - (661,444) 1,047,180 -930035 CR 35 - - - - - (250,000) 250,000 -930036 CR 36 - - - - - (37,539) 37,539 -930119 CR 119 17,888 - 17,888 100,000 - (100,000) 17,888 -

1,971,251 (497,415) 1,473,836 2,940,000 - (2,922,974) 1,456,810 -WATER

WOODSTOCK CAPACITY INCREASE (PRIOR PROJECT) - - - - (612,994) - 612,994 -960149 WDSTK - CITY PROJECT OVERSIZING 5,580 - 5,580 - - - 5,580 -960171 WDSTK - CR17 BPS 3,770 - 3,770 - - - 3,770 -TILLSONBURG NORTH AREA BOOSTED PRESSURE ZONE (PRIOR PROJECT) - - - - (150,000) - 150,000 -INGERSOLL PUMPHOUSE UPGRADES (PRIOR PROJECT) - - - - (157,961) - 157,961 -PLATTSVILLE WATER TOWER (PRIOR PROJECT) - - - - (80,000) - 80,000 -THAMESFORD CR 2 / BANNER ROAD WATERMAIN (PRIOR PROJECT) - - - - (40,000) - 40,000 -

9,350 - 9,350 - (1,040,955) - 1,050,305 -WASTEWATER

950141 TRUNK SEWER JACK POOLE 24,880 - 24,880 - 8,293 - 16,588 -950163 WDSTK - LANSDOWNE PS 97,582 - 97,582 - - - 97,582 -950227 TBURG - NORTH ST TRUNK SEWER 395,894 - 395,894 - 59,384 - 336,510 -950311 ING - WWTP 6,536,807 (1,336,807) 1 5,200,000 - 4,000,000 - 1,200,000 -TAVISTOCK WWTP EXPANSION / UPGRADE (PRIOR PROJECT) - - - - (318,138) - 318,138 -PLATTSVILLE DEBT RECOVERY LAGOON UPGRADES (PRIOR PROJECT) - - - - (170,000) - 170,000 -THAMESFORD WWTP PHASE 1 UPGRADES (PRIOR PROJECT) - - - - (111,838) - 111,838 -950810 DRUMBO - WWTP 31,304 - 31,304 - 9,520 - 21,784 -950169 WDSTK - BIOSOLIDS CENTRALIZED STORAGE FACILITY 118,259 - 118,259 - - - 32,322 85,937


For the Year Ended December 31, 2017W/WW

YTD UNFINANCED TOTAL RATES & DEVELOPMENT OTHERDESCRIPTION EXPENDITURES CAPITAL TAXATION ** RESERVES ** RESERVES ** CHARGES SOURCES*

950269 TBURG - BIOSOLIDS CENTRALIZED STORAGE FACILITY 28,108 - 28,108 - - - 7,678 20,430950369 ING - BIOSOLIDS CENTRALIZED STORAGE FACILITY 26,073 - 26,073 - - - 7,121 18,951950769 THAMESFORD - BIOSOLIDS CENTRALIZED STORAGE FACILITY 2,081 - 2,081 - - - 603 1,479950869 DRUMBO - BIOSOLIDS CENTRALIZED STORAGE FACILITY 2,442 - 2,442 - - - 668 1,774

7,263,430 (1,336,807) 5,926,623 - 3,477,221 - 2,320,831 128,571LIBRARY

TILLSONBURG LIBRARY (PRIOR PROJECT) - - - (24,242) - - 24,242 -NORWICH LIBRARY PRINCIPAL DEBT PAYMENT - - - (53,958) - - 53,958 -

- - - (78,200) - - 78,200 -

LAND AMBULANCE915010 EMS MILL ST - DEBT RECOVERY - - - (40,000) - - 40,000 -

FACILITIESADMINISTRATION BUILDING (PRIOR PROJECT) - - - (28,000) - - 28,000 -

ADMINISTRATIONSUSTAINABLE COMMUNITY SERVICING PLAN 28,016 - 28,016 - - 14,008 14,008 -

9,272,047 (1,834,222) 7,437,825 2,793,800 2,436,266 (2,908,966) 4,988,154 128,571

* Other Revenue Sources includes Capital Contributions and CWWF funding.** Negative reserve amounts represent a replenishment of previous funding from reserves.1 Will be funded by debenture at the completion of project.2 Will be funded by the Town of Tillsonburg and future development in accordance with PW2017-51 Storm Drainage Channel Cost Sharing Agreement, Town of Tillsonburg and County of Oxford.


OXFORD COUNTYDEVELOPMENT CHARGES

This document summarizes the Development Charges according to the following by-laws:5578-2014 County-Wide 5579-2014 Woodstock Water & Wastewater5580-2014 Tillsonburg Water & Wastewater5581-2014 Ingersoll Water & Wastewater5582-2014 Thamesford Water & Wastewater

5583-2014 Norwich Water & Wastewater5584-2014 Tavistock Water & Wastewater5585-2014 Plattsville Water & Wastewater5586-2014 Drumbo Water & Wastewater

This document is intended as a guide. Refer to the approved by-law and consult with County or municipal staff to determine charges that apply to specific development proposals. The by-laws are available in full at Customer Service in the Oxford County Administration Building during regular business hours (weekdays from 8:00 a.m. to 4:30 p.m.). They are also available on the County website at: www.oxfordcounty.ca/developmentcharges.

In addition to the County Development Charges, most area municipalities in Oxford County also have Development Charges by-laws. Refer to the Building Department of the area municipality or follow the website link above to the summary tables for information regarding the municipal Development Charges, where provided.

PURPOSE OF DEVELOPMENT CHARGESDevelopment Charges are used to finance capital works required for new housing and non-residential development. The county-wide by-law applies to most new residential and some forms of non-residential development on lands within the boundaries of Oxford County. Development Charges generated from the county-wide charge go toward growth-related costs associated with general government, roads, administration building, land ambulance and library services. The water and wastewater by-laws apply specifically to development of lands within a geographic area defined in each by-law that generally corresponds to the service area named in the title. Development Charges generated from these by-laws go toward growth-related costs associated with the provision of water and wastewater infrastructure. All County Development Charge by-laws were passed under the authority of the Development Charges Act, (1997) on June 25, 2014.

SCHEDULE OF CHARGESThe County schedule of Development Charges is summarized in the tables below and on the following page. For area municipal charges, please refer to the appropriate municipal by-law. The schedule sets out the charges that are applicable to residential development by unit type: single and semi-detached dwelling units; apartments; and other multiples. Charges applicable to non-residential development are levied per square metre of gross floor area. To determine the total County charge, add the county-wide charges to the applicable area-specific charges for water and wastewater. For areas not serviced by municipal sewer and water services, only the county-wide charge applies. The County Development Charges will be indexed on April 1st of each year in accordance with the annual change in the Statistics Canada Construction Price Index.

COUNTY-WIDE DEVELOPMENT CHARGE RATES SCHEDULE - RESIDENTIAL AND NON-RESIDENTIALEFFECTIVE APRIL 1, 2018 TO MARCH 31, 2019

RESIDENTIAL DWELLINGS1 NON-RESIDENTIAL2

Service ComponentSingle Detached &

Semi Detached

APARTMENTS

Other Multiples $/sq m of Floor Area2-Bedroom &

LargerBachelor & 1-Bedroom

General Government $6 $3 $2 $4 $0.03Land Ambulance 141 77 58 98 0.68Administration Building 68 38 28 48 0.35Roads & Related 2,226 1,214 911 1,541 10.45Library Service1 432 236 177 299 0.00Total $2,873 $1,568 $1,176 $1,990 $11.511The charge for library service is not applicable in Woodstock 2 Industrial buildings exempt

CONTINUED ON REVERSE


AREA-SPECIFIC DEVELOPMENT CHARGE RATES SCHEDULE - RESIDENTIAL AND NON-RESIDENTIALEffective April 1, 2018 to March 31, 2019

RESIDENTIAL DWELLINGS1 NON-RESIDENTIAL2

Area ServiceSingle Detached &

Semi Detached

APARTMENTSOther

Multiples $/sq m of Floor Area2-Bedroom &

LargerBachelor & 1-Bedroom

Woodstock Water $2,932 $1,823 $1,383 $2,458 $7.60Wastewater $3,177 $1,975 $1,498 $2,664 $8.25

Tillsonburg Water $1,409 $965 $723 $1,327 $7.30Wastewater $9,609 $6,581 $4,935 $9,049 $50.24

Ingersoll Water $1,854 $998 $749 $1,373 $8.99Wastewater $10,961 $5,899 $4,423 $8,110 $53.14

Thamesford Water $2,321 $1,150 $863 $1,581 $9.60Wastewater $6,633 $3,287 $2,465 $4,519 $27.33

Norwich Water $2,460 $1,299 $975 $1,787 $10.62Wastewater $9,010 $4,761 $3,570 $6,546 $38.90

Tavistock Water $1,073 $687 $516 $945 $5.63Wastewater $10,731 $6,868 $5,151 $9,443 $56.11

Plattsville Water $4,581 $1,981 $1,486 $2,725 $36.45Wastewater $13,010 $5,626 $4,220 $7,735 $103.39

Drumbo Water $0 $0 $0 $0 $0.00Wastewater $8,581 $3,711 $2,783 $5,101 $30.30

1For exemptions that may apply, check applicable by-laws 2 Industrial buildings exempt

APPLICATIONDevelopment Charges are imposed against all lands to be developed, where the development requires:• Passing of a zoning by-law or zoning by-law

amendment;• Approval of a minor variance;• Granting of part lot control;

• Approval of a plan of subdivision;• Approval of consent to sever land;• Approval of condominium; or• Issuance of a building permit

EXEMPTIONSCertain exemptions apply and reference should be made to the applicable by-law(s) concerning exemptions.

COLLECTIONDevelopment Charges imposed by the County under its by-laws are to be calculated and payable in full, either in money or by the provision of services as may be agreed upon, or by credit granted by the County under the provisions of the Act, on the date that a building permit is issued. For area-specific water and wastewater services, Development Charge calculation and payment may be due on the date the owner and the municipality enter into a subdivision or consent agreement, in relation to lands where such planning approval is required.

STATEMENT OF TREASUREREach year, the County Treasurer will issue a statement for the preceding year including opening and closing balances of the Development Charge reserve funds and of transactions relating to the funds; identify all assets whose capital costs were funded under a development charge by-law during the year and the manner in which any capital cost not funded under the by-law was or will be funded; and a statement as to compliance with the Statement of Treasurer requirements of the Development Charges Act.

The annual statement of the County Treasurer regarding Development Charges Reserve Funds will be available by April 30th of the subsequent year. This statement may be viewed by the public at Customer Service in the Oxford County Administration Building (21 Reeve Street, Woodstock, Ontario) during regular business hours (weekdays from 8:00 a.m. to 4:30 p.m.) or on the County website at: www.oxfordcounty.ca.

ADDITIONAL INFORMATIONOxford CountyP.O. Box 1614, 21 Reeve Street, Woodstock, ON N4S 7Y3Phone: 519-539-9800 | 1-800-755-0394 | Fax: 519-421-4713www.oxfordcounty.ca | [email protected]


Report No: PHES 2018-08

PUBLIC HEALTH & EMERGENCY SERVICES Council Date: April 11, 2018

Page 1 of 3


From: Director, Public Health & Emergency Services

Appointments to Board of Health of the Oxford Elgin St. Thomas Health Unit

RECOMMENDATION 1. That, in accordance with the Health Protection and Promotion Act, R.S.O. 1990, c.

H.7, the Council of the County of Oxford hereby appoints Warden Mayberry, _________________, _________________ and _____________ to the Board of Health of the Oxford Elgin St. Thomas Health Unit, as of May 1, 2018, the date named by proclamation of the Lieutenant Governor, for the remainder of the 2014-2018 term of Council.

REPORT HIGHLIGHTS

This report seeks Council appointment of the Warden, __________, __________ and __________ to the new Board of Health that will govern the Oxford Elgin St. Thomas Health Unit.

Implementation Points

With the approval of this report, County of Oxford will have appointed the designated number of municipal members to the Board of Health of the Oxford Elgin St. Thomas Health.in preparation for the commencement of its operations effective May 1, 2018.

Financial Impact

No financial impacts are anticipated to result from adopting the recommendation contained within this report. The Treasurer has reviewed this report and agrees with the financial impact information.

Strategic Plan (2015-2018) County Council adopted the County of Oxford Strategic Plan (2015-2018) at its regular meeting held May 27, 2015. The initiative contained within this report supports the Values and Strategic Directions as set out in the Strategic Plan as it pertains to the following Strategic Directions:

3. i. A County that Thinks Ahead and Wisely Shapes the Future – Influence federal and provincial policy with implications for the County by:

- Advocating for fairness for rural and small urban communities - Advocating for human and health care services, facilities and resources, support for local

industry, etc. - Advocating for federal and provincial initiatives that are appropriate to our county



Page 2 of 3

DISCUSSION

Background On January 10, 2018 Council approved report PHES 2018-01 seeking the required regulatory changes to the Health Protection & Promotion Act (HPPA) including Regulation 553 Areas Comprising Health Units and Regulation 559 Designation of Municipal members of Boards of Health. The need to establish a Transition Governance Committee (TGC) was identified for the purpose of providing oversight and advice related to interim governance and operational frameworks and transition processes to the ESTPH and OCPH Boards of Health on matters imperative to achieving a fully operational board of health when amendments to the Health Protection and Promotion Act (HPPA) come into force. Terms of Reference were approved and Warden Mayberry and Councillor Talbot were appointed to be the County of Oxford members on the committee (PHES 2018-04). It was the intention of both parties that municipal members appointed to the Transition Governance Committee be appointed by their respective municipal councils to serve on the Board of Health. The TGC met on March 29th and April 5th, with additional meetings scheduled for April 24th and 25th. The Committee is providing oversight for the development of board of health policies and bylaws, senior executive job descriptions, and other such tasks directly associated with the merger. It should be noted that the Board of Health for Oxford Elgin St. Thomas Health Unit may establish, at their discretion, the Committee as an Ad Hoc Committee of the Board following May 1, 2018 when the regulatory amendments to the HPPA come into force.

Comments On April 4, 2018, the required regulatory changes to the Health Protection and Promotion Act were posted on the Government of Ontario’s e-Laws with May 1, 2018 being the date in which the amended regulatory changes come into force. Amendments to Regulation 553 under Schedule 27 establishes the legal name of the new health unit as Board of Health for the Oxford Elgin St. Thomas Health Unit and the area comprised as being County of Oxford, County of Elgin and City of St. Thomas.

Amendments to Regulation 559 establishes that the new Oxford Elgin St. Thomas Health Unit Board of Health will have eight municipal members as follows: four members appointed by the Municipal Council of the County of Oxford, two members to be appointed by the Municipal Council for the County of Elgin, and two members to be appointed by the Municipal Council for the City of St. Thomas.

Conclusions It is recommended that Council appoint the Warden, ______________, ______________ and ______________ as the County of Oxford municipal members on the Board of Health for the

http://www.oxfordcounty.ca/portals/15/Documents/News%20Room/11978_0_Jan_10_2018_Agenda_version01.pdf#page=87

http://www.oxfordcounty.ca/portals/15/Documents/News%20Room/11981_0_Feb_28_2018_Agenda_version01.pdf#page=217

https://www.ontario.ca/laws/regulation/900553

https://www.ontario.ca/laws/regulation/900559



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Oxford Elgin St. Thomas Health Unit as of May 1, 2018 for the remaining period of this term of Council.

SIGNATURES

Departmental Approval: Original signed by Lynn Beath Director, Public Health & Emergency Services

Approved for submission:

Original signed by

Peter M. Crockett, P.Eng. Chief Administrative Officer

Report No: PS 2018-01

PARAMEDIC SERVICES Council Date: April 11, 2018

Page 1 of 10


From: Manager of Paramedic Services

Oxford County Paramedic Services Ten-Year Comprehensive Master Plan

RECOMMENDATIONS 1. That Report No. PS 2018-01, titled “Oxford County Paramedic Services Ten-Year

Comprehensive Master Plan” be received;

2. And further, that Council endorse in principle the recommendations of the Paramedic Services Ten-Year Comprehensive Master Plan as detailed in Report PS 2018-01;

3. And further, that Council authorize staff to proceed with the implementation plan for additional Near-Term paramedic service level increases in Q4-2018 as set out in Report No. PS 2018-01;

4. And further that, Council approves the Q4-2018 implementation costs of $241,500 for service enhancements in Tillsonburg to be funded by the General Reserve;

5. And further, that further Paramedic Services enhancements as outlined in Report PS 2018-01 be presented for Council consideration as part of the 2019 Budget and Business Plan.

REPORT HIGHLIGHTS To obtain County Council approval to proceed with the implementation plan as referenced in

Report PS 2018-01 and based on the final consultant report for a Ten-Year Comprehensive Master Plan for the delivery of Paramedic Services.

Implementation Points Upon approval of the recommendations contained in this report staff will phase in the remaining recommendations for 2018 Near-Term frontline paramedic enhancements in the ten-year Comprehensive Master Plan starting in Q4 of 2018. The recommendations for 2019 Near-Term frontline paramedic enhancements and other Near-Term Internal Support recommendations will be included in the 2019 departmental budget submission.



Page 2 of 10

Financial Impact Land ambulance costs are funded at a 50:50 cost share between the Ontario government and the Upper Tier Municipality. As the provincial funding formula is based on the prior year actual approved costs, provincial funding for service level increases typically lag one year behind the actual implementation. The chart below shows the annual provincial/municipal cost sharing based on staff’s recommended service enhancement implementation plan.

Start Date

Service Enhancement

FTE Req’d

2018 Cost 2019 Cost 2020 Cost 2021 Cost

Budget Prov. Budget Prov. Budget Prov. Budget Prov.

Q4 - 2018

Increase deployment in Tillsonburg by adding to existing 10 hr x 5 day/week to operate 24/7

5.7 $241,500 $0 $966,000 $120,750 $966,000 $483,000 $966,000 $483,000

Q1 – 2019

Increase deployment at Drumbo station in Blandford-Blenheim, from 20/7 to 24/7

1.3 - - $227,700 $0 $227,700 $113,850 $227,700 $113,850

Q4 - 2019

Increase deployment in Woodstock by adding a daytime ambulance, 12/7

4.0 - - $345,000 Plus Capital $290,000 for an add’l fully-equipped ambulance

$0 $690,000 $50,000 Capital replacement

$172,500 $690,000 $50,000 Capital replacement

$345,000

Total - Operating 11.0 $241,500 $0 $1,538,700 $120,750 $1,883,700 $769,350 $1,883,700 $941,850

Net Levy Impact - $241,500 $1,417,980 $1,114,350 $941,850

- Capital - - - $290,000 $50,000 $50,000

As indicated in the chart above, service enhancements in Tillsonburg are proposed to be implemented in Q4-2018 for a cost of $241,500. It is recommended that those costs be funded from the General Reserve which has a 2018 year end budget balance of $2.96 million. Considering the service enhancement is an ongoing operational commitment, the 2019 budget will experience a funding shortfall of $845,250, being the difference between the cost of the enhanced service and provincial funding of $120,750 (50% of prior year’s costs). To mitigate the 2019 funding shortfall, staff will recommend phasing in the burden on the levy with the use of reserves until provincial funding reaches the full 50% share in 2020. In terms of funding the enhanced services proposed for implementation in 2019, further consideration will be given when developing the 2019 business plan and budget. The Treasurer has reviewed this report and agrees with the financial impact information.



Page 3 of 10

Risks/Implications Should additional paramedic service hours not be added to the system in the Near-Term to address the current system pressures, response times for high priority calls (Priority 3 & 4) will continue to increase and Oxford County will be at risk of not meeting our target response time performance plan as reported to the Ministry of Health and Long Term Care. In recent years, in order to meet overall system response times, Paramedic Services has relied extensively on rural ambulances to cover both rural townships and urban centres of the County (Woodstock, Tillsonburg and Ingersoll). In 2017 Paramedic Services was not able to achieve its response time targets for the most emergent call types in any of the rural municipalities (Blandford-Blenheim, Norwich, South-West Oxford, East Zorra-Tavistock and Zorra). Further degrading of rural coverage and response times will continue without increase to the urban centre service levels. Further, as the projected call demand is expected to increase significantly over the next 10 years, if service level increases are not implemented on a phased in approach over the period, future demand growth will not be manageable. Strategic Plan (2015-2018) County Council adopted the County of Oxford Strategic Plan (2015-2018) at its regular meeting held May 27, 2015. The initiative contained within this report supports the Values and Strategic Directions as set out in the Strategic Plan as it pertains to the following Strategic Directions: 1. ii. A County that Works Together – Enhance the quality of life for all of our citizens by:

- Adapting programs, services and facilities to reflect evolving community needs - Working with community partners and organizations to maintain / strengthen public

safety

3. iii. A County that Thinks Ahead and Wisely Shapes the Future - Demonstrated commitment to sustainability by:


o Potential impacts to the vulnerable population in our community o Life cycle costs and benefit/costs, including debt, tax and reserve levels and

implications

5. ii. A County that Performs and Delivers Results - Deliver exceptional services by:

- Regularly reviewing service level standards to assess potential for improved access to services / amenities

- Conducting regular service reviews to ensure delivery effectiveness and efficiency - Developing and tracking key performance indicators against goals and report results - Identify best practices and appropriate benchmarking



Page 4 of 10

DISCUSSION Background On November 18, 2015, Report No. PHES 2015-05, Council approved to engage the services of an experienced consultant with specialized modeling software and expertise in the areas of data analysis, geolocation, and resource utilization. The consultant was to assist with the preparation of an operational and financial plan to complement existing call mitigation strategies with a plan to address future call volume growth. Through a competitive RFP process, APEXPRO Consulting Inc. was selected to work with staff to develop a ten-year Comprehensive Master Plan for the delivery of Paramedic Services in Oxford County.

The “Comprehensive Master Plan for Oxford County Paramedic Services” as prepared by APEXPRO Consulting Inc., dated February 16, 2018 (Attachment 2), is intended to review and assess the County’s current paramedic services drawing on evidentiary information, industry leading (best) practices, and provincial legislation and standards, to attain the following objectives:

Recommendations for optimal and efficient paramedic services; Long-term (10-year) projection of future land ambulance service demand growth; Service level targets linked to measurable outcomes; Long-term (10-year) projections of future staffing and resourcing needs, including

stations; Recommendations for slowing down future cost escalations while maintaining service

excellence.

Comments Paramedic Services Snapshot

Significant findings of the consultant included that;

The service is well-managed, in full compliance to provincial regulations, with management making effective use of available resources to ensure service efficiency. Staff at all levels of the organization are well-trained and committed to service quality. Staff’s morale is good, as are external relations with local health care, Fire Departments and London Ambulance Communication Centre (dispatch).

Logistics support services are well-configured. Ambulances are well-equipped. Stations are suitably outfitted, and they are well-situated for reasonably rapid ambulance response to medical emergencies.

The demand for Paramedic services in Oxford County is increasing at over 5% per annum. In 2016, OCPS performed 22,650 ambulance responses.

http://www.oxfordcounty.ca/portals/15/Documents/News Room/5040_0_Nov_18_2015_Agenda_version01.pdf#page=313



Page 5 of 10

Fifty-five percent (55%) were dispatched as high priority (Priority 3 and 4), to urgent and potentially life-threatening medical emergencies; and 43% were dispatched as a standby posting (Priority 8), usually to one of the urban centres, when that area was temporarily without ambulance coverage.

The rapidly escalating Paramedic Service demand is adversely impacting ambulance response time to medical emergencies. (Figure 1)

Figure 1: Ambulance Call Response Forecasts

In 2014, the 90th percentile response time County-wide was 10:39, i.e., 90 percent of all Priority 4 calls (potentially life-threatening medical emergencies) were responded to in 10 minutes and 39 seconds, or less. In 2016, because of rapidly increasing EMS demand, the 90th percentile response time County-wide was 8% longer, at 11:31. Urban centre response times range between 07:47 and 08:24 at the 90th percentile. Rural township response times are significantly longer, ranging between 11:57 and 19:57. (Figure 2)

Paramedic Services relies extensively on rural ambulances to cover both rural townships and urban centres of the County (Woodstock, Tillsonburg and Ingersoll).

In prior years, when urban centre call volumes were lower, this practice worked well. Today it does not. Rural ambulances spend most of their shifts out of their coverage zones, performing standby emergency coverage and/or responding to calls for service in the urban centres. The situation has resulted in a significant urban-rural imbalance where rural service levels and response times are inordinately degraded, due to urban coverage issues. (Figure 2)

2011 2016 2021 2026 2031 2036

HIGH 18,229 22,650 26,500 31,600 38,100 46,400

MEDIUM 18,229 22,650 26,000 30,800 35,700 38,700

LOW 18,229 22,650 24,800 28,700 33,000 35,400

0

10,000

20,000

30,000

40,000

50,000

RESPONSES (PR 1‐4 & 8)

AMBULANCE RESPONSE FORECASTS



Page 6 of 10

Figure 2: Urban – Rural Imbalance

URBAN CENTRES RURAL TOWNSHIPS

Unit Hour Utilization (UHU) 34% - day 31% - night

45% - day 51% - night

Availability to Respond to Next Medical Emergency

66% - day 69% - night

55% - day 49% - night

Response Time to Medical Emergencies (90th Percentile)

07:47 to 08:24 11:57 to 19:57

Key Finding Recommendations

The staff recommendations below address the key findings contained in the Comprehensive Master Plan (CMP). The findings formed by the consultant in the CMP arise from investigation based on evidentiary analyses, peer comparisons, industry leading (best) practices, provincial legislation, prior experience, and frequent consultations with management and other personnel employed by the Oxford County Paramedic Services (OCPS) organization.

Recommendation 1: Staff recommend that Oxford County Paramedic Services continue to deliver all of the Ministry of Health medical directives available in the Advanced Life Support Patient Care Standards for the Primary Care Paramedic (PCP) level of care. Current evidence does not support the additional cost and training required to implement an Advanced Care Paramedics level of service for Oxford County. Staff will continue to monitor the medical evidence and in consultation with the Regional Base Hospital recommend appropriate enhancements to the PCP level of care

Reference CMP sec 2.9: Oxford County’s paramedic service operates at the Primary Care Paramedic level (PCP). The paramedics are PCPs who also are certified by the Base Hospital to perform IV starts. This standard is consistent with that of multiple EMS peers, particularly those serving largely rural areas. In consideration of the ‘scope of practice’ research presently underway, we recommend that OCPS maintain a PCP service level standard, and forego any consideration of advancement to ACP, until the research is complete.

Recommendation 2: Staff recommend that frontline paramedic enhancements should be focused on transport capable ambulances. Staff will continue to review optimal deployment of frontline resources and specifically in regard to single paramedic response units and their applicability for Oxford County.

Reference CMP sec 2.12: Paramedic Response units (PRU) are intended to supplement, not replace patient transport capable ambulances. In consideration of the County’s rapidly escalating EMS service demand, which is adversely impacting



Page 7 of 10

ambulance response time and workload, we recommend that enhancing core services by staffing additional transport capable ambulances should be Oxford County’s near-term priority.

Recommendation 3: Staff recommend further review of operational support or administrative requirements and the work associated with each position, existing capacity and other available internal department support available. If any additional FTE needs for Internal Support positions are determined to be required they will be presented as part of future year(s) budget requests.

Reference CMP sec 3.7: We recommend that OCPS should increase Logistics staffing by a minimum of 0.5 FTE. This will not only reduce Logistics’ reliance on other areas of the organization, but also better align the Logistics staffing level to that of comparable EMS services

Reference CMP sec 3.11: A Performance Analyst should be recruited as a full-time OCPS resource. The incumbent will assemble, assess and provide OCPS management with EMS operations-related statistical data that will be used to improve the services.

The incumbent will also be responsible to establish and track Key Performance Indicators (KPI) pertaining to OCPS’ participation in the CREMS Community Paramedicine program; and to periodically carry out investigations, e.g., research into additional Community Paramedicine programs for Oxford County

Recommendation 3: Staff recommend that an initial increase in the number of ambulances could be accomplished by keeping a single vehicle beyond the normal life of six years with additional capital for ongoing replacement being requested through future budget request if required. The current number of ambulance vehicles is lean in respect to the number of available ambulances to staff for daily deployment based on the current staffing levels. However, to date this has not lead to a situation where paramedic staff are without an available ambulance vehicle due to a repair or service. Staff believe that the current number of ambulances is at the maximum efficiency to ensure availability while also ensuring appropriate maintenance and repairs are completed. Should there be an increase to the number of staffed ambulances on a daily bases as a result of service level enhancements, this ratio of ambulance vehicles may then be insufficient to ensure spare availability and therefore increasing the number of ambulances should be considered.

Reference CMP sec 4.4: OCPS’ experience shows that as many as 2 ambulances are out of service, for maintenance or repairs, at any given time. Therefore, in practice, the fleet operates with only 2 spares. This practice is inconsistent with industry leading practices (i.e., it is too lean), and we recommend that the service should acquire at least 1 additional fully-equipped spare ambulance – preferably in the near term.

Recommendation 4: Staff recommend the adoption of an annual unit hour utilization (UHU) level of 35%. Measurement KPIs will be established and monitored by staff to identify any change or pattern in the system performance against the established targets for future recommendations on the allocation of current resources and/or changes to paramedic service levels and long-term resource needs.



Page 8 of 10

Reference CMP sec 9: Oxford County should adopt an annual Unit Hour Utilization (UHU) level of 35% as its preferred, upper limit service level target for the County’s land ambulance stations. At this UHU the likelihood that each station will have at least one ambulance available to respond to the next call will be 65% or better, and station response times will improve beyond current levels

Reference CMP sec 12): We therefore recommend that OCPS should monitor year-over-year call volume changes, and periodically adjust the forecast level of resourcing in tandem

Recommendation 5: Staff recommend the adoption of Near-Term resource needs to address existing system performance pressures. To phase in the additional paramedic resources staff recommend Council support the implementation timeline contained in this report. Increasing Paramedic call demand of approximately 5% per annum from 2011 – 2016 (Figure 1) has degraded ambulance availability and system response times. Despite mitigation strategies such as managing hospital offload times, reducing non-emergency transfers and community referral programs, there has been a more significant decrease to rural ambulance availability and an increase to response times (Figure 2) due to coverage and call response in the urban areas.

Reference CMP sec’s 10.1, 10.2 & 13.2: In our opinion, the urban-rural workload imbalance needs to be resolved – preferably in the near term (2018), if financially feasible.

To this end, we recommend that urban centres of the County be made more self-sufficient. More specifically, the County should staff additional ambulance resources in urban centres of highest call concentration (Woodstock and Tillsonburg), as discussed in Sections 10.2 to 10.4 of the (Master Plan) report.

These corrective actions will not only reduce the volume of rural ambulance responses in the urban centres, they will also substantially improve ambulance availability in the rural townships of the County, and shorten response times to medical emergencies arising therein.

In consideration of the above information we recommend;

- The Tillsonburg weekday car coverage should be increased from 10/5 to 24/7, so that Tillsonburg station would operate with 2 ambulances, each staffed 24/7.

- An additional daytime ambulance should be implemented in the City of Woodstock, so that the City would be served by 3 ambulances on days and 2 at night. For such purposes, the County will need to purchase an additional, fully-equipped ambulance. This additional ambulance can be stationed at the Mill base, where there is ample spare garage capacity.

- Additional night coverage in Blandford-Blenheim by staffing the Drumbo ambulance for the entire night to be 24/7. Currently, that ambulance is not staffed from 02:00 to 06:00 hours.

Recommendation 6: Staff recommend that in conjunction with the South West LHIN, a review of Community Paramedic program options with the goal of reducing demand for emergency calls for Paramedic Services in Oxford County be undertaken. The feasibility of any such programs would be brought back to Council for consideration. Community Paramedic programs in other municipalities have shown some success in mitigating emergency call demand to varying



Page 9 of 10

degrees. Additionally, some municipalities have been successful in obtaining funding for such programs through their Local Health Integration Network (LHIN).

Reference CMP sec 14.2: We recommend that OCPS consider expanding its participation in Community Paramedicine beyond the current Community Referral (CREMS) program; potentially to include some of the other programs listed above, as means for sustaining service excellence, while also curbing its future EMS resourcing needs, and corresponding cost escalations.

Previously, we recommended that OCPS should recruit a Performance Analyst whose responsibilities will be to assemble and assess EMS operations-related statistical data that will be used to improve the services.

We recommend that this incumbent should also be responsible to establish and track Key Performance Indicators (KPI) pertaining to OCPS’ participation in the CREMS Community Paramedicine program; and to investigate additional Community Paramedicine programs for Oxford County.

Reference CMP sec 14.3: While OCPS’ participation in CREMS has reduced ambulance transports, the potential exists to decrease the numbers further. Research confirms that a large proportion of CREMS referrals involve seniors whose injuries are due to suffering a fall. For this reason, we recommend that OCPS should promote ‘falls prevention for seniors’ as a priority strategy for the County’s CREMS program.

Implementation Plan In order to address the current system pressure and address the increase in paramedic service response time to high priority calls (Priority 3 & 4) across the County, as well as to return resources and response capacity specifically to the rural communities in the County, an additional 11,990 paramedic service unit hours are required to maintain service response levels. Specifically, the recommended implementation for the Near-Term frontline paramedic service level increases (additional service hours) be done in three phases as per the below chart.

Phase Start Date Coverage Area # of Ambulances

Hrs/Day

Days/Year

Annual Service Hours

Annual Operating Cost

1 Q4- 2018 Tillsonburg (add to existing 10 hour x 5 day/week)

1 14 365 6,150 $966,000

2 Q1- 2019 Drumbo (add to existing 20 hour x 7 day/week)

1 4 365 1,460 $227,700

3 Q4 – 2019 Woodstock 1 12 365 4,380 $690,000



Page 10 of 10

Service enhancements in Tillsonburg are proposed to be implemented in Q4-2018 for a cost of $241,500. It is recommended that those costs be funded from the General Reserve which has a 2018 year end budget balance of $2.96 million. Ongoing annual operational costs for the three phases are outlined in the chart above. Conclusions Adopting the staff key finding recommendations of this report in respect to the Comprehensive Master Plan will support the effective, efficient and accountable delivery of paramedic services in Oxford County for the next ten years, 2018 – 2028. Beginning with the Tillsonburg additional service hour increases in Q4 of 2018 and continuing with a phased in approach for additional unit hours in Woodstock and Drumbo coverage areas will address the areas of high call demand and reduce the current high demand on the rural stations to provide coverage to the more urban centres. Staff will bring forward business cases for Woodstock and Drumbo coverage increases and any additional enhancements as part of future budget process.

SIGNATURES Report Author: Original signed by Ben Addley Manager of Paramedic Services Approved for submission: Original signed by


ATTACHMENTS Attachment 1: APEXPRO Council Presentation, March 9, 2018 Attachment 2: COMPREHENSIVE MASTER PLAN FOR OXFORD COUNTY PARAMEDIC SERVICES – Final Report, February 16, 2018

COMPREHENSIVE MASTER PLAN FOR OXFORDCOUNTY PARAMEDIC SERVICES

COUNCIL PRESENTATION

APRIL 11, 2018

APEXPRO CONSULTING INC.

ATTACHMENT 1 Report No: PS 2018-01

PROJECT OBJECTIVE

1

To develop a Comprehensive Master Plan that will support effective and efficient delivery of Oxford County Paramedic Services (OCPS) for the next 10 years, including:

• Recommendations for optimal and efficient paramedic services

• Service level targets linked to measurable outcomes

• Long-term (10-year) projections of future EMS demand growth, ambulance resourcing needs, and stations

• Recommendations for curbing future cost escalations while maintaining service excellence

Assessment is based on evidentiary information, industry leading (best) practices, provincial legislation, and frequent consultations with OCPS personnel.

Project direction was provided by the County’s CAO; Director, Public Health & Emergency Services; Director, Corporate Services; and Manager/Chief, OCPS.

2

• 98 personnel, including 52 full-time and 36 part-time paramedics

• 12 ambulances and 4 command vehicles

• 7 stations situated across the County

• Well-managed, in full compliance to provincial legislation, with management making effective use of available resources to ensure service efficiency

• Staff are well-trained and committed to service quality

• Logistics support is well-configured, and

SERVICE SNAPSHOT

ambulances are well equipped.

• Stations are suitably outfitted, and they are well-situated for reasonably rapid ambulance response to medical emergencies.

DEMAND FOR EMS SERVICES

In Oxford County, the demand for EMS services is increasing at over 5% per annum.

3

2011 2012 2013 2014 2015 2016TOTAL 18,229 19,019 18,692 18,993 19,803 22,650PR 8 STANDBY 7,114 7,130 7,277 8,196 8,740 9,817PR 3 & 4 8,899 9,564 9,807 10,405 10,759 12,407PR 1 & 2 2,216 2,325 1,608 392 304 426

0

5,000

10,000

15,000

20,000

25,000

AMBU

LAN

CE R

ESPO

NSE

S

OCPS AMBULANCE RESPONSE TRENDS

In 2016, OCPS performed 22,650 ambulance responses:

• 55% dispatched as high priority with lights and siren (Priority 3 & 4)

• 43% standby, usually to one of the urban centres (Priority 8)

• 2% non-urgent (Priority 1 & 2)

RESPONSE TIME to MEDICAL EMERGENCIES

Rapidly escalating EMS demand is adversely impacting ambulance response time.

In 2014, the response time County-wide was 10:39 at the 90th percentile. In 2016, because of rapidly increasing EMS demand, it had increased by 8%, to 11:31.

4

5

OCPS relies extensively on rural ambulances to cover both rural townships and urban centres of the County (Woodstock, Tillsonburg and Ingersoll).

When urban call volumes were lower, this practice worked well. Today it does not.

Rural ambulances spend most of their shifts out of their coverage zones, performing standby emergency coverage and/or responding to calls for service in the urban centres.

• In 2016 rural-based ambulances responded to only 1,200 calls in their own coverage zones, whereas

• They attended almost 8 times as many calls elsewhere, including 7,500 standby postings and 1,500 calls for service in the urban centres.

The situation has resulted in a significant URBAN-RURAL IMBALANCE, where:

• EMS performance in URBAN centres aligns artificially to industry leading (best) practices, since numerous calls are offloaded to rural ambulances, and

• RURAL service levels and response times are inordinately degraded – this due to urban offload.

AMBULANCE DEPLOYMENT IN OXFORD COUNTY

6

URBAN-RURAL IMBALANCE (2016)


Unit Hour Utilization (UHU) - 34% - day- 31% - night

- 45% - day- 51% - night


- 66% - day- 69% - night

- 55% - day- 49% - night

Response Time to Medical Emergencies (90th Percentile) 07:47 to 08:24 11:57 to 19:57

• EMS performance in URBAN centres aligns artificially to industry leading (best) practices, since numerous calls are offloaded to rural ambulances.

• RURAL service levels and response times are inordinately degraded – this due to urban offload.

• Urban-rural imbalance in 2017 is likely worse due to rapidly rising EMS demand. Situation will only worsen since EMS demand is projected to continue to increase.

7

The following service enhancements should be implemented in the near-term (2018-2019), if financially feasible. Costs are in 2017 dollars and are potentially eligible for MOHLTC subsidy at 50%.

NEAR-TERM RECOMMENDATIONS: (a) FRONT LINE

…. / cont’d

FRONT LINE SERVICE ENHANCEMENTS FTEREQ’T

EST.OPERATING COST

EST.CAPITAL COST

1. 2018: Two (2) full-time paramedics should be recruited to staff ambulances at night (in lieu of Supervisors)

- Approved by Council in December 2017

- Intended primarily to restore in-the-field supervision

2 FTE $220,000 / year --

2. 2018: Increase deployment in Tillsonburg to two (2) ambulances, each operating 24/7

- Will increase deployment to four 12-hour shifts, up from current 2.6 [1 amb 24/7 and another 10/5]

- Response time to improve by about 1 minute in Tillsonburg, and 0.5 minute in the rural townships

7.7 FTE $966,000 / year --

8

NEAR-TERM RECOMMENDATIONS: (a) FRONT LINE

FRONT LINE SERVICE ENHANCEMENTS FTEREQ’T

EST.OPERATING COST

EST.CAPITAL COST

3. 2019: Increase deployment at Mill station in Woodstock to two (2) daytime ambulances, 12/7

- Presently operates w’ 1 daytime ambulance, 12/7

- Building on Rec’n #2, rural response time to improve by about 1.25 minutes, and by 1 minute County-wide

5.5 FTE $690,000 / year

$290,000for an add’l fully-

equipped ambulance

$50,000 / yearcapital replacement

4. 2019: Increase deployment at Drumbo station in Blandford-Blenheim, from 20/7 to 24/7

- To fill night-time hours 02:00 to 06:00

- Will further improve rural service levels at night

1.8 FTE $227,700 / year --

5. 2019: Increase the fleet by one (1) additional, fully-equipped spare ambulance

- Ambulance availability is often strained because 1 to 2 ambulances are frequently out of service

-- --

$290,000for an add’l fully-

equipped ambulance

$50,000 / yearcapital replacement

9

NEAR-TERM RECOMMENDATIONS: (b) INTERNAL SUPPORT

INTERNAL SUPPORT ENHANCEMENTS FTEREQ’T

EST.OPERATING COST

EST.CAPITAL COST

1. 2018: A Performance Analyst should be recruited as a full-time OCPS resource

- To assemble and analyze EMS operations-related statistical data that will be used to improve the services

- Currently there is no such in-service capability

1 FTE $120,000 / year --

2. 2019: In-service Logistics support should be augmented by at least 0.5 FTE

- These functions are the responsibility of a Supervisor/Deputy Chief, supported by a Coordinator of EMS Logistics

- The workload exceeds their combined capacity, and they frequently request assistance from others

0.5 FTE $60,000 / year --

10

The “Low Growth” EMS demand forecast is the basis for our projections of Oxford County’s long-term EMS resourcing needs.

• High priority response volume (Priority 3 and 4) increases at 4.6% per annum

• Total response volume (Priority 1-4 & 8) increases to 33,000 by 2031.

LONG-TERM EMS DEMAND FORECASTS

We recommend that OCPS should monitor year-over-year call volume changes.

If EMS demand increases at a faster pace, then the County’s needs will increase more rapidly. Conversely, if EMS demand growth slows down, then so also will the County’s requirements slow down.

11

RESOURCING NEEDS SUMMARY

CURRENTSITUATION

NOW NEEDS(2018-19)

LONG-TERM NEEDS(IN 10-15 YEARS)

Fleet - 12 fully-equipped ambulances

- 4 command vehicles

- 14 fully-equipped ambulances


- 17 fully-equipped ambulances


Ambulance Coverage -Daytime

- 8 staffed weekdays

- 7 on weekends

- 9 staffed every day of the week

- 11 staffed every day of the week

Ambulance Coverage -Night-Time

- 6 at peak

- 5 from 02:00 to 06:00 hours

- 7 staffed every night of the week

- 8 staffed every night of the week

Stations - 7 stations - 7 stations - Replace Bysham w’ a larger station, or

- Build a 3rd station for Woodstock

Beyond the immediate catch-up, resourcing should suffice for 10+ years; albeit, OCPS should continue to monitor year-over-year call volume changes.

12

• OCPS participates in Community Referral EMS (CREMS), connecting seniors and persons with chronic conditions to community-based care services.

• Such patients are high-volume EMS users who otherwise, would call 9-1-1 frequently for ambulance services.

• While OCPS’ participation in CREMS has reduced ambulance transports, the potential exists to decrease the numbers further.

• Research confirms that a large proportion of CREMS referrals involve seniors whose injuries are due to suffering a fall. OCPS should promote “falls prevention for seniors” as a priority strategy for CREMS.

• OCPS should track CREMS effectiveness using definitive KPI, and periodically adjust the program as appropriate.

• OCPS should investigate additional Community Paramedicine programs for Oxford County.

CURBING COSTS WHILE SUSTAINING SERVICE EXCELLENCE

13

RECAP OF 2018 RECOMMENDATIONS

2018 REQUIREMENT STATUS

1) Two (2) full-time paramedics should be recruited to staff ambulances at night (in lieu of Supervisors)

Included in 2018 operating budget

2) Deployment in Tillsonburg should be increased to two (2) ambulances, each operating 24/7

7.7 FTE at an est’d $966,000 / year

Should be incorporated into 2018 operating budget if financially feasible

3) A Performance Analyst should be recruited as a full-time OCPS resource

1 FTE at an est’d $120,000 / year

Should be incorporated into 2018 operating budget if financially feasible

FINAL REPORT

COMPREHENSIVE MASTER PLAN FOR

OXFORD COUNTY PARAMEDIC SERVICES


FEBRUARY 16, 2018

CLI ENT LOGO

Attachment 2 Report No.: PS 2018-01

www.apexproconsultinginc.com Tel 416.505.7897 [email protected]

APEXPRO CONSULTING INC. EXCELLENCE COMMITMENT PARTNERSHIP – EVERY CLIENT! EVERY TIME!

30 KARL CRT . , THORNHILL ON L4 J 8H7 CANADA

February 16, 2018

Mr. Ben Addley

Manager/Chief

Oxford County Paramedic Services

Public Health & Emergency Services

377 Mill Street,

Woodstock, ON N4S 7V6

Dear Mr. Addley:

COMPREHENSIVE MASTER PLAN FOR OXFORD COUNTY PARAMEDIC SERVICES

It is with great pleasure that we submit this report containing the results of our review and

assessment of Oxford County Paramedic Services (OCPS). The main findings and

recommendations arising from the assessment are as follows.

OCPS is well‐managed, in full compliance to provincial regulations, with management making

effective use of available resources to ensure service efficiency. This notwithstanding, rapidly

increasing EMS demand is adversely impacting ambulance availability and response time to

medical emergencies.

OCPS relies extensively on rural ambulances to cover both rural townships and urban centres of

the County (Woodstock, Tillsonburg and Ingersoll). In prior years, when urban centre call

volumes were lower, this practice worked well. Today it does not. Rural ambulances spend

most of their shifts out of their coverage zones, performing standby emergency coverage

and/or responding to calls for service in the urban centres.

The situation has resulted in a significant urban‐rural imbalance, where EMS performance in

URBAN centres aligns artificially to industry leading (best) practices, since numerous calls are

offloaded to rural ambulances; and RURAL service levels and response times are inordinately

degraded – this due to urban offload.

In December 2017, following a presentation of our initial findings, Oxford County Council

authorized OCPS to recruit 2 additional full‐time paramedics to staff night‐time ambulance

shifts, in lieu of the Platoon Superintendents. This change will restore in‐the‐field supervision,

but it will not materially increase unit availability or help to improve urban‐rural balance.

To this end, our report recommends several near‐term service enhancements which if

implemented, should substantially improve the urban‐rural balance, as well as ambulance

availability and response times in the rural townships.

…./2

APEXPRO CONSULTING INC. Page 2

EXCELLENCE COMMITMENT PARTNERSHIP – EVERY CLIENT! EVERY TIME!

February 16, 2018

Ben Addley, Manager/Chief, Oxford County Paramedic Services

Service enhancements of highest priority are listed below. They should be implemented in the

near‐term (2018‐2019), if financially feasible.

1. Increase deployment in Tillsonburg to two (2) ambulances, each operating 24/7.

As described in the body of the report, current ambulance staffing in Tillsonburg is 1

ambulance 24/7 and 1 ambulance for 10 hours a day on weekdays. The recommended

service enhancement should improve response time by about 1 minute in Tillsonburg, and

by 0.5 minute in the rural townships.

2. Increase deployment at Mill station in Woodstock to two (2) daytime ambulances, 12/7.

As described in the body of the report, this daytime change, together with the night‐time

change in Recommendation #1 above, should improve response time by about 1.25

minutes in the rural townships, and by 1 minute County‐wide.

As requested, our report also includes long‐term (15‐year) forecasts of future EMS demand

growth for Oxford County, and projections of the County’s long‐term EMS resourcing needs.

Our findings in this regard are as follows.

The recommended near‐term service enhancements are needed to address OCPS’ immediate

(catch‐up) requirements. However, if implemented, then the resulting level of EMS resourcing

should suffice for the next 10+ years, assuming a low growth EMS demand forecast. Regardless,

OCPS should continue to monitor year‐over‐year call volume changes.

Thank you for giving us the opportunity to work on this most interesting assignment.


Marvin Rubinstein

President

Enc.

FINAL REPORT: COMPREHENSIVE MASTER PLAN FOR OXFORD COUNTY PARAMEDIC SERVICES

Table of Contents

APEXPRO CONSULTING INC. i

COVER LETTER

EXECUTIVE SUMMARY ......................................................................................................... iv

E.1 Project Overview .......................................................................................... iv E.2 Service Snapshot ........................................................................................... iv E.3 Near‐Term Recommendations: Front Line ................................................... vi E.4 Near‐Term Recommendations: Internal Support ....................................... viii E.5 EMS Operating Budget, 2018 ..................................................................... viii E.6 Long‐Term (15‐Year) Forecasts ..................................................................... ix E.7 Curbing Costs While Sustaining Service Excellence ....................................... x

1 INTRODUCTION ......................................................................................................... 1

1.1 Background ................................................................................................... 1 1.2 Project Objectives ......................................................................................... 1 1.3 Jurisdictional Context ................................................................................... 1 1.4 Strategic Context .......................................................................................... 2 1.5 Project Direction ........................................................................................... 3 1.6 Project Approach .......................................................................................... 3 1.7 Stakeholder Consultations ............................................................................ 3 1.8 Acknowledgement ........................................................................................ 3

2 PROVINCIAL LEGISLATION & STANDARDS ................................................................. 4

2.1 Ambulance Act, 1990 .................................................................................... 4 2.2 Regulations & Standards .............................................................................. 5 2.3 Provincial Principles ...................................................................................... 5 2.4 Central Ambulance Communications Centre (CACC) ................................... 6 2.5 Dispatch Priorities ......................................................................................... 7 2.6 Ambulance Response Time ........................................................................... 8 2.7 Response Time Performance Plan (RTPP) .................................................... 8 2.8 Base Hospital ................................................................................................ 8 2.9 Primary and Advanced Care Paramedics ...................................................... 9 2.10 Ambulance Service Review (ASR) ............................................................... 10 2.11 Provincial Funding ...................................................................................... 10 2.12 Paramedic Response Unit ........................................................................... 11 2.13 Provincial Plans for Enhancement of Paramedic Services .......................... 11

3 OCPS ORGANIZATIONAL REVIEW ............................................................................ 13

3.1 Paramedic Services Pyramid ....................................................................... 13 3.2 Organizational Structure ............................................................................. 14 3.3 Field Supervision ......................................................................................... 17 3.4 Paramedic Training & Education ................................................................ 18 3.5 Quality Assurance ....................................................................................... 19 3.6 Fleet and Equipment Management ............................................................ 20 3.7 Supply Asset Management ......................................................................... 23 3.8 Scheduling & Payroll ................................................................................... 24


Table of Contents (cont’d)

APEXPRO CONSULTING INC. ii

3.9 EMS Administrative Support....................................................................... 25 3.10 IT Systems Support ..................................................................................... 26 3.11 Performance Analytics ................................................................................ 28

4 EMS INFRASTRUCTURE & SUPPORT ........................................................................ 30

4.1 EMS Facilities .............................................................................................. 30 4.2 EMS Fleet .................................................................................................... 32 4.3 EMS Staffing Pattern ................................................................................... 34 4.4 Spare Ambulances ...................................................................................... 35 4.5 EMS Deployment & Utilization Plan ........................................................... 36 4.6 Standby Emergency Coverage .................................................................... 36 4.7 EMS Shift Overrun ...................................................................................... 37 4.8 Ambulance Offload ..................................................................................... 38 4.9 Medical Tiered Response ............................................................................ 39 4.10 Non‐Ambulance Patient Transfer Services ................................................. 40

5 PARAMEDIC SERVICE COSTS .................................................................................... 42

5.1 Paramedic Service Costs, 2014‐2017 .......................................................... 42 5.2 All‐Inclusive Cost to Fully Staff an OCPS Ambulance .................................. 43 5.3 Incremental Cost to Staff an Additional Ambulance‐Hour ......................... 43

6 PEER COMPARISONS ............................................................................................... 44

6.1 Comparative Spending on EMS .................................................................. 44 6.2 Comparative Resourcing ............................................................................. 46

7 OCPS RESPONSE TRENDS ......................................................................................... 47

7.1 Response Trends, 2011‐2016 ..................................................................... 47 7.2 Response Time Trends, 2011‐2016 ............................................................ 48 7.3 Code Critical Trends, 2016‐2017 ................................................................. 49 7.4 Response Dispersion by Call Origin, 2016 .................................................. 49 7.5 Inter‐Institutional Transfers by OCPS Ambulances, 2016 ........................... 50 7.6 Responses by Station, 2016 ........................................................................ 51 7.7 Monthly, Daily & Hourly Response Profiles, 2016 ...................................... 52 7.8 Time‐on‐Task, 2016 .................................................................................... 53 7.9 Hourly Time‐on‐Task Profile, 2016 ............................................................. 54 7.10 Response Profile by Incident Type, 2016 .................................................... 54 7.11 EMS Demand by Age Cohort, 2016 ............................................................ 55

8 RESPONSE TIME PERFORMANCE PLAN ................................................................... 56

8.1 Canadian Triage Acuity Scale (CTAS) .......................................................... 56 8.2 Response Time Performance Plan (RTPP) .................................................. 57 8.3 Oxford County’s RTPP Targets & Performance, 2013‐2017 ....................... 57 8.4 Response Performance in the SCA Classification ....................................... 59 8.5 Response Profile by Call Urgency (2016) .................................................... 59

9 UNIT HOUR UTILIZATION (UHU) .............................................................................. 61


Table of Contents (cont’d)

APEXPRO CONSULTING INC. iii

10 NEAR‐TERM RESOURCING REQUIREMENTS ............................................................ 62

10.1 Current (2016) Performance Summary ...................................................... 62 10.2 Option 1 – Increase Ambulance Staffing in Tillsonburg.............................. 64 10.3 Option 2 – Increase Ambulance Staffing in Woodstock ............................. 64 10.4 Option 3 (Recommended) .......................................................................... 65

11 LONG‐TERM (15‐YEAR) DEMAND FORECASTS ........................................................ 66

11.1 Key Drivers of Service Demand ................................................................... 66 11.2 Long‐Term (15‐Year) Service Demand Forecasts ........................................ 67 11.3 Geographic Distribution of Future EMS Demand ....................................... 68

12 LONG‐TERM (15‐YEAR) RESOURCING NEEDS .......................................................... 69

12.1 Forecast Coverage Requirements – Daytime ............................................. 69 12.2 Forecast Coverage Requirements – Night Time ......................................... 70 12.3 Forecast Fleet Requirements ...................................................................... 70 12.4 Long‐Term Station Locations ...................................................................... 71

13 EMS COST FORECASTS ............................................................................................. 74

13.1 Near‐Term Service Enhancements: Front Line ........................................... 74 13.2 Near‐Term Service Enhancements: Internal Support ................................. 75 13.3 EMS Operating Budget, 2018 ..................................................................... 76 13.4 Long‐Term Forecast of OCPS Operating Costs............................................ 77 13.5 Long‐Term Cost Forecast for Fleet Expansion ............................................ 77

14 CURBING COSTS / SUSTAINING SERVICE EXCELLENCE ............................................ 79

14.1 Community Paramedicine .......................................................................... 79 14.2 OCPS’ Community Paramedicine Experience ............................................. 81 14.3 Falls Prevention as a Key Strategy for CREMS ............................................ 81

APPENDICES

A. List of Acronyms

B. PCP / ACP Competencies

C. Emergency Responder Training

D. Hourly Response Profiles (2016)

E. Hourly UHU Profiles (2016)


APEXPRO CONSULTING INC. iv

EXECUTIVE SUMMARY

E.1 Project Overview

Oxford County retained APEXPRO Consulting Inc., to undertake the development of a

Comprehensive Master Plan that will support the effective and efficient delivery of Oxford

County Paramedic Services (OCPS), for the next 10 years, 2018‐2028.

The Comprehensive Master Plan is intended to review and assess the County’s paramedic

services drawing on evidentiary information, industry leading (best) practices, and provincial

legislation and standards, to attain the following objectives:

Recommendations for optimal and efficient paramedic services;

Long‐term (10‐year) projection of future land ambulance service demand growth;

Service level targets linked to measurable outcomes;

Long‐term (10‐year) projections of future staffing and resourcing needs, including stations;

Recommendations for curbing future cost escalations while maintaining service excellence.

The recommendations arising from this investigation are based on evidentiary analyses, peer

comparisons, industry leading (best) practices, provincial legislation, prior experience, and

frequent consultations with management and other personnel employed by the Oxford County

Paramedic Services (OCPS) organization.

Project direction was provided by a Steering Committee consisting of the County’s Chief

Administrative Officer; Director, Public Health & Emergency Services; Director, Corporate

Services; and Manager/Chief, Oxford County Paramedic Services.

APEXPRO acknowledges and thanks all stakeholders who contributed to this investigation.

While our report is based in part on stakeholder consultations, APEXPRO in its role as

consultant takes responsibility for the report contents.

E.2 Service Snapshot

Oxford County is the provincially designated agent for delivery of paramedic services, for the

County and its eight constituent communities. Paramedic services are delivered by OCPS, a

division of the Public Health and Emergency Services department.

OCPS operates with a staff of 98, which includes 52 full‐time and 36 part‐time paramedics; and

a fleet of 12 ambulances and 4 command vehicles, from 7 stations situated in Woodstock (2),

Tillsonburg, Ingersoll, Drumbo (Blandford‐Blenheim Township), Embro (Zorra Township) and

Norwich Township.

The service is well‐managed, in full compliance to provincial regulations, with management

making effective use of available resources to ensure service efficiency. Staff at all levels of the

organization are well‐trained and committed to service quality. Staff’s morale is good, as are

external relations with local health care, Fire and CACC (dispatch).


APEXPRO CONSULTING INC. v

Logistics support services are well‐configured. Ambulances are well‐equipped. Stations are

suitably outfitted, and they are well‐situated for reasonably rapid ambulance response to

medical emergencies.

In Oxford County, the demand for EMS services in Oxford County is increasing at over 5% per

annum. In 2016, OCPS performed 22,650 ambulance responses. 1

Fifty‐five percent (55%) were dispatched as high priority (Priority 3 and 4), to urgent and

potentially life‐threatening medical emergencies; and 43% were dispatched as a standby

posting (Priority 8), usually to one of the urban centres, when that area was temporarily

without ambulance coverage.

South‐West LHIN hospitals, including the three hospitals situated in Oxford County, contract

Voyageur Transportation (a non‐ambulance patient transportation service) for non‐urgent

inter‐facility patient transfers. Voyageur has successfully helped to reduce OCPS’ workload by

over 2,000 non‐urgent patient transfers a year. Because of this, OCPS responds to relatively

few calls that are dispatched as non‐urgent (Priority 1 and 2), i.e., about 400 or fewer, a year.

The rapidly escalating EMS demand is adversely impacting ambulance response time to medical

emergencies.

In 2014, the 90th percentile response time County‐wide was 10:39, i.e., 90 percent of all Priority

4 calls (potentially life‐threatening medical emergencies) were responded to in 10 minutes and

39 seconds, or less. In 2016, because of rapidly increasing EMS demand, the 90th percentile

response time County‐wide was 8% longer, at 11:31.

OCPS relies extensively on rural ambulances to cover both rural townships and urban centres of

the County (Woodstock, Tillsonburg and Ingersoll).

In prior years, when urban centre call volumes were lower, this practice worked well. Today it

does not. Rural ambulances spend most of their shifts out of their coverage zones, performing

standby emergency coverage and/or responding to calls for service in the urban centres.

In 2016 rural‐based ambulances responded to only 1,200 calls in their own coverage zones,

whereas they attended almost 8 times as many calls elsewhere, including 7,500 standby

postings and 1,500 calls for service in the urban centres.

The situation has resulted in a significant urban‐rural imbalance, where:

EMS performance in URBAN centres aligns artificially to industry leading (best) practices,

since numerous calls are offloaded to rural ambulances; and

RURAL service levels and response times are inordinately degraded, due to urban offload.

This is shown in Exhibit E.1 (next page).

1 Ambulance response statistics are derived from the Ambulance Dispatch Reporting System (ADRS) database managed by MOHLTC. ADRS data is typically 6 months in arrears – hence the analysis contained within this report is based on data for 2016 and prior years.


APEXPRO CONSULTING INC. vi

EXHIBIT E.1: URBAN‐RURAL IMBALANCE (2016)


Unit Hour Utilization (UHU) - 34% ‐ day - 31% ‐ night

- 45% ‐ day - 51% ‐ night


- 66% ‐ day - 69% ‐ night

- 55% ‐ day - 49% ‐ night

Response Time to Medical Emergencies (90th Percentile)

07:47 to 08:24 11:57 to 19:57

In Woodstock, Ingersoll and Tillsonburg, ambulances operate at Unit Hour Utilization (UHU)

averaging 34% during the day and 31% at night.

In the rural townships (Norwich, Blandford‐Blenheim and Zorra), ambulances operate at

inordinately high UHU measuring 45% during the day and 51% at night. At these inordinately

high UHU, the likelihood that a rural‐based ambulance will be at hand in its primary coverage

zone when a medical emergency arises, is only 55% during the day, and even worse, at night, at

49%.

Urban centre response times range between 07:47 and 08:24 at the 90th percentile. Rural

township response times are significantly longer, ranging between 11:57 and 19:57. The

disparity in urban‐rural response times is also attributed in part to the relatively larger

geography of the rural townships, frequently resulting in longer travel distances.

In our opinion, the performance for urban‐based ambulances (shown above in Exhibit E.1) is

skewed, since numerous urban calls are being offloaded to rural ambulances. We estimate

that, without the rural ambulances’ support, urban‐based ambulances would be operating at

degraded values, i.e., daytime UHU of about 40%, and substantially longer response times.

While 2017 statistics are not readily available, it is our opinion based on rapidly rising EMS

demand, that the urban‐rural imbalance in 2017 is likely worse than that which we have

reported in this document for 2016. Further, the situation will only worsen since EMS demand

is projected to continue to increase.

It is our opinion that the urban‐rural imbalance needs to be resolved – preferably in the near

term (2018), if financially feasible.

E.3 Near‐Term Recommendations: Front Line

To this end, we recommend the near‐term service enhancements listed in Exhibit E.2 (next

page).

The recommendations are spread over two years, 2018 and 2019; this, to soften the near‐term

financial impact. Costs are presented in 2017 dollars. They are the gross costs, which are

potentially eligible for MOHLTC subsidy at 50%.


APEXPRO CONSULTING INC. vii

The recommendations are listed in priority sequence. For the reader’s convenience, each

recommendation is cross‐referenced to the relevant section of this report.

EXHIBIT E.2: FRONT LINE SERVICE ENHANCEMENTS IN PRIORITY SEQUENCE

FRONT LINE SERVICE ENHANCEMENTS FTE

REQ’T EST.

OPERATING COST EST.

CAPITAL COST

1. 2018: Two (2) full‐time paramedics should be recruited to staff ambulances at night (in lieu of Supervisors)

‐ Approved by Council in December 2017

‐ Restores in‐the‐field supervision / will improve unit availability and reduce code criticals

‐ For more information refer to Section 3.3

2 FTE $220,000 / year ‐‐


‐ Will increase deployment to four 12‐hour shifts, up from current 2.6 [1 amb 24/7 and another 10/5]

‐ Response time to improve by about 1 minute in Tillsonburg, and 0.5 minute in the rural townships


7.7 FTE $966,000 / year ‐‐


‐ Presently operates w’ 1 daytime ambulance, 12/7

‐ Building on Rec’n #2, rural response time to improve by about 1.25 minutes, and by 1 minute County‐wide


5.5 FTE $690,000 / year

$290,000 for an add’l fully‐

equipped ambulance

$50,000 Capital

replacement

4. 2019: Increase deployment at Drumbo station in Blandford‐Blenheim, from 20/7 to 24/7

‐ To fill night‐time hours 02:00 to 06:00

‐ Will further improve rural service levels at night


1.8 FTE $227,700 / year ‐‐

5. 2019: Increase the fleet by one (1) additional, fully‐equipped spare ambulance

‐ Ambulance availability is often strained because 1 to 2 ambulances are frequently out of service


‐‐ ‐‐


equipped ambulance

$50,000 Capital

replacement


APEXPRO CONSULTING INC. viii

E.4 Near‐Term Recommendations: Internal Support

The following near‐term enhancements are intended to improve internal support services.

EXHIBIT E.3: INTERNAL SUPPORT SERVICE ENHANCEMENTS

INTERNAL SUPPORT SERVICE ENHANCEMENTS FTE

REQ’T EST.

OPERATING COST EST.

CAPITAL COST

1. 2018: A Performance Analyst should be recruited as a full‐time OCPS resource

‐ To assemble and analyze EMS operations‐related statistical data that will be used to improve the services

‐ Currently there is no such in‐service capability


1 FTE $120,000 / year ‐‐

2. 2019: In‐service Logistics support should be augmented by at least 0.5 FTE

‐ These functions are the responsibility of a Supervisor/Deputy Chief, supported by a Coordinator of EMS Logistics

‐ The workload exceeds their combined capacity, and they frequently request assistance from others


0.5 FTE $60,000 / year ‐‐

E.5 EMS Operating Budget, 2018

On December 18, 2017 Oxford County Council approved a 3% increase in the EMS operating

budget, bringing it to $11.68 million for 2018. The increase includes:

1.5% cost of living adjustment (COLA)

2 additional full‐time paramedics to staff ambulances at night (in lieu of Supervisors).

The approved 2018 budget excludes the following recommendations for 2018. It is our opinion

that these resourcing enhancements are still needed in the near term:

Increase deployment in Tillsonburg to two (2) ambulances, each operating 24/7. This will

require 7.7 additional FTE. The estimated cost is $966,000 per annum.

A Performance Analyst should be recruited as a full‐time OCPS resource. The estimated

cost is $120,000 per annum.

In 2016 Oxford County’s spending on land ambulance services was about $95 per resident. For

peers, the annual spending was on average 25% higher, with most ranging between $103 and

$159 per resident. In 2017, the County’s spending on land ambulance services was about $98

per resident; and with the approved increase in budget for 2018 it will be about $101 per

resident.


APEXPRO CONSULTING INC. ix

E.6 Long‐Term (15‐Year) Forecasts

Population growth, and seniors’ population growth (65+ years), are the principal drivers of land

ambulance service demand. Seniors (65+ years) presently account for 18% of the County’s

total population, and they generate about 50% of all land ambulance calls. It is forecast that by

2031, seniors will account for 25% or more of Oxford County’s population, at which time they

will place considerably higher demand on OCPS’ land ambulance resources.

APEXPRO developed three long‐term forecasts of future EMS demand for Oxford County. Our

‘high growth’ forecast is a forward looking trend line extrapolation of changes in response

volume, 2011 to 2016. Our ‘medium growth’ forecast is based on a regression analysis of

changes in response volume, 2011 to 2016, relative to population changes in the same period.

The results are projected forward using the MOF long‐term population forecast.

Our ‘low growth’ forecast is also based on a regression analysis of changes in response volume,

2011 to 2016, relative to population changes in the same period; however, in this instance, the

results are projected forward using Oxford County’s adopted long‐term population forecast, as

documented in their “Growth Forecast and Employment Lands Study (GFEL)”.

The ‘low growth’ EMS demand forecast is the basis for our projections of Oxford County’s long‐

term EMS resourcing needs. The forecast projects that high priority response volumes (Priority

3 and 4) will increase at 4.6% per annum; and that total response volumes (Priority 1‐4 and 8)

will increase to 33,000 by 2031.

We recommend that OCPS should monitor year‐over‐year call volume changes. If EMS demand

increases at a faster pace, then the County’s needs will increase more rapidly. Conversely, if

EMS demand growth slows down, then so also will the County’s requirements slow down.

Oxford County’s EMS resourcing needs are summarized in Exhibit E.4. As shown by the

exhibit, beyond the immediate catch‐up, EMS resourcing should suffice for 10+ years; albeit,

OCPS should continue to monitor year‐over‐year call volume changes.

EXHIBIT E.4: RESOURCING NEEDS SUMMARY

CURRENT

SITUATION

NOW NEEDS

(2018‐19)

LONG‐TERM NEEDS

(IN 10‐15 YEARS)

Fleet ‐ 12 fully‐equipped

ambulances

‐ 4 command

vehicles

‐ 14 fully‐equipped

ambulances

‐ 4 command

vehicles

‐ 17 fully‐equipped

ambulances

‐ 4 command

vehicles

Ambulance Coverage –

Daytime

‐ 8 staffed weekdays

‐ 7 on weekends

‐ 9 staffed every day

of the week

‐ 11 staffed every

day of the week

Ambulance Coverage ‐

Night‐Time

‐ 6 at peak

‐ 5 from 02:00 to

06:00 hours

‐ 7 staffed every

night of the week

‐ 8 staffed every

night of the week


APEXPRO CONSULTING INC. x

Stations ‐ 7 stations ‐ 7 stations ‐ Replace Bysham

with a larger

station, or

‐ Build a 3rd station

for Woodstock *

* Woodstock is projected to generate 55% of all new EMS demand. Preferred locations for these options are shown

in Section 12 of this report.

E.7 Curbing Costs While Sustaining Service Excellence

APEXPRO was asked to investigate Community Paramedicine as an option by which to curb

future cost escalations while sustaining service excellence. Community Paramedicine is a

provincially sponsored program in which paramedics go beyond their usual emergency

response role, to connect patients in need of ongoing care support (i.e., seniors, or persons

with mental health or chronic conditions) to more appropriate home‐based, or community‐

based, care services.

Positive benefits reported by established Community Paramedicine programs have been

sufficiently compelling for the Ontario Government to: incorporate Community Paramedicine

as a key health care strategy; reaffirm its funding support for Community Paramedicine

programs province‐wide; and introduce legislative changes (Bill 160), which if passed, will

provide paramedics with increased flexibility to deliver alternative, non‐hospital care options.

OCPS participates in Community Referral EMS (CREMS), connecting seniors and persons with

chronic conditions to community‐based care services. Such patients are high‐volume EMS

users who otherwise, would call 9‐1‐1 frequently for ambulance services.

While OCPS’ participation in CREMS has reduced ambulance transports, the potential exists to

decrease the numbers further.

Research confirms that a large proportion of CREMS referrals involve seniors whose injuries are

due to suffering a fall. For this reason, we recommend that OCPS should promote ‘falls

prevention for seniors’ as a priority strategy for the County’s CREMS program.

OCPS should track CREMS effectiveness using definitive KPI, and periodically adjust the

program as appropriate. OCPS should also investigate additional Community Paramedicine

programs for Oxford County.

We previously recommended that OCPS should recruit a Performance Analyst. We recommend

that the above tasks be assigned to that incumbent’s portfolio.


APEXPRO CONSULTING INC. 1

1 INTRODUCTION

1.1 Background

On March 23, 2017, the County of Oxford issued a Request‐for‐Proposals to secure the services

of a professional consultant ….

…. to undertake the development of a Comprehensive Master Plan that will support the

effective and efficient delivery of Oxford County Paramedic Services (OCPS), for the next 10

years, 2018‐2028 ….

APEXPRO Consulting Inc.’s involvement in this project is the direct result of the competitive

tendering process. Our proposal was submitted on April 7, 2017 and we were awarded the

project on April 26, 2017.

1.2 Project Objectives

The Comprehensive Master Plan is intended to review and assess the County’s paramedic

services drawing on evidentiary information, industry leading (best) practices, and provincial

legislation and standards, to attain the following objectives:

Recommendations for optimal and efficient paramedic services;

Long‐term (10‐year) projection of future land ambulance service demand growth;

Service level targets linked to measurable outcomes;

Long‐term (10‐year) projections of future staffing and resourcing needs, including stations;

Recommendations for slowing down future cost escalations while maintaining service

excellence.

1.3 Jurisdictional Context

Oxford County is the provincially designated agent for delivery of paramedic services, for the

County and its 8 constituent communities: Woodstock; Ingersoll; Tillsonburg; and the

Townships of Blandford‐Blenheim, East Zorra‐Tavistock, Norwich, Southwest Oxford, and Zorra.

The County’s jurisdiction, shown in Exhibit 1.1 (next page), covers 2,040 square kilometers and

houses approximately 110,862 residents (according to the 2016 Census).

Paramedic services are delivered by Oxford County Paramedic Services (OCPS), a division of the

Public Health and Emergency Services department. OCPS operates from 7 paramedic stations

situated across the County, in Woodstock (2), Tillsonburg, Ingersoll, Drumbo (Blandford‐

Blenheim Township), Embro (Zorra Township) and Norwich Township.


APEXPRO CONSULT ING INC . 2

EXHIBIT 1.1: JURISDICTIONAL CONTEXT

1.4 Strategic Context

In recent years Oxford County has initiated multiple strategic initiatives, intended to sustain the

community and the well‐being of its residents. This Comprehensive Master Plan for the Oxford

County Paramedic Services, is a progression of that earlier work. Recommendations arising

from the Paramedic Services Master Plan will support/enable the achievement of the

Corporate Goals.

EXHIBIT 1.2: STRATEGIC CONTEXT

Oxford County Strategic Plan for Vibrant Communities, 2015-18Future Oxford Community Sustainability Plan, 2015Oxford County Community Wellbeing Survey, 2016

Comprehensive Master PlanTo support the effective, efficient and accountable delivery of Oxford

County Paramedic Services, and ensure appropriate goals and

resourcing of staff and equipment, for the next 10 years

Strategic Plans Serve as Inputs to Paramedic Services Assessment

Master Plan Recommendations Support / Enable Corporate Goals



1.5 Project Direction

Project direction was provided by a Steering Committee consisting of the County’s Chief

Administrative Officer; Director, Public Health & Emergency Services; Director, Corporate

Services; and Manager/Chief, Oxford County Paramedic Services.

The Manager/Chief, Oxford County Paramedic Services also served as the County’s Project

Manager for this consulting assignment, and our day‐to‐day contact for both technical and

administrative matters.

1.6 Project Approach

This engagement by APEXPRO Consulting Inc., is informed by industry leading (best) practices,

with peer comparisons, and provincial legislation and standards, as the foundation for our

work. The assessment and recommendations are based on:

Evidentiary information, including incident data records, and financial and operational

performance metrics;

A visual appraisal of existing paramedic service facilities; and

Frequent consultations with management and other personnel employed by the Oxford

County Paramedic Services (OCPS) organization.

1.7 Stakeholder Consultations

During the project we consulted with over 60% of the Service’s full‐time personnel, and over

35% of the part‐timers, including:

Manager/Chief

2 (of 2) Supervisor/Deputy Chiefs

4 (of 4) Platoon Superintendents

Executive Assistant

Supervisor of EMS Education 2

Coordinator of EMS Logistics

28 (of 50) full‐time paramedics, including

14 (of 38) part‐time paramedics

Several executives of OPSEU Local 114 (i.e., the paramedics’ bargaining unit).

1.8 Acknowledgement

APEXPRO acknowledges and thanks all stakeholders who contributed to this investigation.

While our report is based in part on stakeholder consultations, APEXPRO in its role as

consultant takes responsibility for the report contents.

2 In this document, the following terms have the same meaning and are used interchangeably: “Paramedic Services”, “Land Ambulance Services”, and “Emergency Medical Services (EMS)”.



2 PROVINCIAL LEGISLATION & STANDARDS

2.1 Ambulance Act, 1990

The Ontario Ambulance Act provides the overall legislative framework for ambulance services

in the province of Ontario. In respect of land ambulance services, the Ambulance Act

empowers the Minister of the MOHLTC with authority to: 3

Establish a balanced and integrated system of ambulance services, and communication

services used in dispatching ambulances.

Establish standards for the management, operation and use of ambulance services and to

ensure compliance with those standards.

Monitor, inspect and evaluate ambulance services, and investigate complaints respecting

ambulance services.

Establish regions and districts for the purposes of ambulance and communication services.

Designate hospitals as Base Hospitals that shall monitor the quality of the care provided by

ambulance services in the regions and districts established by the Minister.

Establish, maintain and operate communication services, alone or in co‐operation with

others, and to fund such services.

Establish and operate centres for the training of ambulance and communication services

personnel, alone or in co‐operation with others.

Section 3 of the Act assigns upper‐tier municipalities (UTM) accountability for:

All costs associated with the provision of land ambulance services in the municipality,

notwithstanding any grant that they may receive; and

Ensuring the proper provision of land ambulance services in the municipality in accordance

with local needs.

Section 3 of the Act notwithstanding, Section 4 of the Act grants the Minister authority to

designate a delivery agent (DDA) for the provision of land ambulance services in any

geographic area of the Province. Section 4 of the Act also assigns DDA similar accountabilities

to those listed above for UTM.

Various other provincial legislations govern specific aspects of ambulance services delivery e.g.:

Ambulance Services Bargaining Act, which ensures the continuation of essential ambulance

services in the event of a strike by ambulance workers; and Health Insurance Act, which defines

the insurable costs of ambulance services.

3 A land ambulance service is intended to mean all services provided by an ambulance service, in connection with the transportation of persons by land.



2.2 Regulations & Standards

Regulation 257/00 gives substance to the legislative requirements set out in the Ontario

Ambulance Act, specifying:

Certification requirements and standards for operators of ambulance services

‐ Certification Standards for Operators of Land and Air Ambulance Services

‐ Ambulance Service Communicable Disease Standards

‐ Basic & Advanced Life Support Patient Care Standards

‐ Ontario Ambulance Documentation Standards

‐ Vehicle Design Standards for Ambulances and Emergency Response Vehicles

‐ Ambulance Equipment Standards.

Qualifications for employment as a paramedic

Requalifying examinations for employment as a paramedic

Patient care and documentation standards

Obligations of communications services, base hospital programs, and land ambulance

services that are funded by the province

Response time performance plan requirements for ambulance service providers

List of controlled acts that may be performed by paramedics trained to the primary,

advanced and critical care levels.

Regulation 129/99 provides the legislative framework by which a UTM/DDA can recover, or

apportion, land ambulance service costs among two or more service areas.

2.3 Provincial Principles

MOHLTC requires Ontario land ambulance services to abide by the following provincial

principles.

To be ACCESSIBLE to all residents of the Province, regardless of socio‐economic or

demographic status. Central Ambulance Communications Centers (CACCs) are responsible

to deploy rapid and borderless ambulance services. UTM/DDA are responsible to provide

reasonable levels of ambulance resourcing and access.

To serve as an INTEGRATED component of the province’s health‐care system. Patient

transport by ambulance between health care facilities for medically essential services is a

part of this system. When called upon by CACC, UTM/DDA are responsible to provide

patient transport by ambulance between health care facilities for medically essential

services.

To be SEAMLESS across jurisdictional borders, regardless of political, administrative or

other artificially imposed boundaries. The CACC is responsible to deploy a medical

response to each incident using the closest available, and most appropriate ambulance to

meet the needs of the patient.



To be medically, operationally and financially ACCOUNTABLE for the quality of the service.

To ensure patient care quality, each ambulance operator is required to establish and

maintain an in‐service program for quality assurance oversight.

To ensure that ambulance services remain RESPONSIVE to changes in the health care,

demographic, socio‐economic and medical environments.

2.4 Central Ambulance Communications Centre (CACC)

Provision of land ambulance services is a shared provincial‐municipal responsibility. UTM/DDA

are responsible to provide reasonable levels of ambulance resourcing within their designated

areas; whereas, MOHLTC, by way of a province‐wide network of CACCs, is responsible to

properly dispatch the UTM/DDA land ambulance resources.

Using telephone and radio communications systems, and computer aided dispatch (CAD)

systems, CACC personnel serve as the critical link between callers and the medical assistance

they require. By maintaining up‐to‐the‐moment information on the location and availability of

each ambulance in their dispatch area, and in neighboring dispatch areas, CACCs can:

Quickly and efficiently evaluate incoming calls to determine the nature and urgency of the

medical emergency, and assign each call a dispatch priority ranging from Priority 1

(deferrable) to Priority 4 (urgent, requiring an ambulance to be deployed with flashing

lights and siren).

Rapidly deploy borderless ambulance services.

Direct a medical response to each incident using the closest available, and most

appropriate ambulance to meet the needs of the patient.

Arrange temporary standby coverage while an ambulance is occupied on another call i.e.,

temporary posting of an ambulance from one station to another, or to an alternate

geographic location, to maintain emergency coverage.

Coordinate a response involving multiple ambulances.

Coordinate a medical tiered response involving a non‐ambulance emergency responder

(i.e., Fire or Police).

The CACC’s responsibilities also include:

Provide callers with pre‐arrival first aid instruction.

Coordinate communications during patient transport with the destination hospital, or with

the Base Hospital.

Document all aspects of each call in a provincial database known as the Ambulance

Dispatch Reporting System (ADRS). The ADRS database is a primary source of information

for assessing land ambulance service performance, and funding requirements.

The CACC, situated in London Ontario, is the primary dispatch centre for the Oxford County

Paramedic Service (OCPS).



2.5 Dispatch Priorities

Most CACCs, including the London CACC, use a medical triage software system known as

“Dispatch Priority Card Index (DPCI)” to rapidly assess and assign a dispatch priority to each

incoming request.

Dispatch priority ranges from Priority 1 (deferrable) to Priority 4 (urgent requiring an

ambulance to be deployed with flashing lights and siren), as below.

PRIORITY 1 ‘DEFERRABLE’: This refers to a non‐urgent call that does not have an associated

time element (e.g., a patient being transferred from hospital to a long‐term care facility).

Such calls may be temporarily delayed without being physically detrimental to the patient.

PRIORITY 2 ‘SCHEDULED’: This refers to a non‐urgent call that does have an associated time

element (e.g., a patient transport from one hospital to another for a scheduled diagnostic,

treatment or other form of medical appointment). The time element is not set by patient

convenience, but rather by the availability of the resources at the receiving facility.

PRIORITY 3 ‘PROMPT’: This refers to an urgent but non life‐threating call, where a

moderate delay will not adversely affect the outcome (e.g., a patient under professional

care who is stable and not in immediate danger, who requires transport to hospital for

additional treatment). For such calls, ambulances are dispatched without lights and siren.

PRIORITY 4 ‘URGENT’: This refers to a call where the patient has a life‐threatening or

potential life‐threatening condition, where a delay in medical intervention and transport

can have an adverse effect on outcome (e.g., a patient with acute chest pain or serious

trauma). For such calls, a rapid response is crucial, and ambulances are dispatched with

flashing lights and siren.

In this document, the term ‘high priority’ is intended to mean ambulance responses that are

dispatched as Priority 3 and 4; and the term ‘non‐urgent’ is intended to mean ambulance

responses dispatched as Priority 1 and 2.

CACC may also deploy an ambulance as a Priority 8 ‘Standby’. This refers to a temporary

posting of an ambulance from one station to another, or to an alternate geographic location, to

maintain emergency coverage, e.g., posting an ambulance midway between its service area

and the service area of an adjacent municipality that is temporarily without ambulance

coverage. From this position, the ambulance will provide coverage to both service areas, until

the latter’s own coverage is restored.

Within Oxford County’s service area this includes temporarily posting a rural‐based ambulance

to an urban community, when that community is temporarily without ambulance coverage.

Standbys do not involve patient contact. While on standby an ambulance may be dispatched to

a call involving a patient. When this occurs, the standby designation is replaced by one of the

above four dispatch priorities.



2.6 Ambulance Response Time

Ambulance response time is defined as the interval T2‐T4, where T2 is the time that an

ambulance crew is notified of the call, and T4 is the time of their arrival on scene; this as

depicted in Exhibit 2.1.

Ambulance response time consists of two components: chute time (T2‐T3), which is typically 60

seconds; and drive time (T3‐T4), which is influenced by multiple factors, including traffic

volume, roadway conditions, weather, and distance travel.

EXHIBIT 2.1: AMBULANCE CALL CONTINUUM

Prior to an amendment introduced in July 2008, Regulation 257/00 under the Ambulance Act,

required land ambulance delivery agents to report the 90th percentile response time (T2‐T4),

for all calls to which they were deployed as a Priority 4 with flashing lights and siren.

Reporting the 90th percentile response time for Priority 4 calls is no longer a legislated

requirement. Regardless, tracking Priority 4 call response times at the 90th percentile, and at

other fractile percentages (i.e., 80th and 50th percentiles), is still a useful Key Performance

Indicator (KPI) of the effectiveness of a land ambulance service.

In 2016, OCPS operated at a 90th percentile response time of 11:31, i.e., 90 percent of all

Priority 4 calls were responded to in 11 minutes and 31 seconds, or less.

2.7 Response Time Performance Plan (RTPP)

Regulation 257/00 under the Ambulance Act requires every municipality that is provincially

designated as an ambulance delivery agent, to establish a Response Time Performance Plan

(RTPP) specifying ambulance response time targets by Canadian Triage Acuity Scale (CTAS)

classification levels. The regulation also requires municipalities to report service performance

by CTAS classification; this, based on percentile achievement.

By Regulation, an RTPP plan is to be submitted to MOHLTC annually, about two months prior to

the start of each funding year; and a report on service performance is to be submitted

annually, about three months after the funding year is concluded.

Canadian Triage Acuity Scale (CTAS) classification levels, and Oxford County’s Response Time

Performance Plan by CTAS classification, are discussed in Section 8 of this report.

2.8 Base Hospital

Provincially funded Base Hospitals are responsible to certify paramedics; delegate medical acts;

and monitor and evaluate the services that paramedics provide. In chief, paramedics operate

under the license of a Base Hospital Medical Director (a physician).

T2Crew

Notified

T0Call

Received

T4CrewArrivesScene

T3Crew GoesMobile

T6ArrivalHospital

T5Crew

DepartsScene

T7Call

Cleared



The Base Hospital for the Oxford County service area, is the Southwestern Ontario Regional

Base Hospital Program, which operates out of the London Health Sciences Centre, in London

Ontario.

2.9 Primary and Advanced Care Paramedics

A Primary Care Paramedic (PCP) is a graduate of a two‐year community college paramedic

program who, on completion of the course, has successfully passed the provincial exam for

designation as an Advanced Emergency Medical Care Assistant (A‐EMCA). Once they are hired,

they must also successfully certify with the Regional Base Hospital Medical Director, to

participate in controlled acts at the PCP level.

An Advanced Care Paramedic (ACP) is a graduate of the two‐year community college PCP

program, who takes an additional year of schooling to progress to the advanced care level.

Upon completing the 3 years, they must successfully pass a provincial exam administered by

MOHLTC, and be successfully certified by the Regional Base Hospital Medical Director, to

participate in controlled acts at the ACP level.

Regulation 257/00 sets out the controlled acts that may be performed at the PCP and ACP

levels.

Both PCPs and ACPs must also successfully complete mandatory continuing medical education

(CME) courses on an annual basis, to maintain their qualifications and certifications under the

regional base hospital program. For additional detail, refer to Appendix B.

Ongoing research by the Paramedic Association of Canada (PAC), provincial regulatory bodies

and educational institutions, is expected to define the future ‘scope of practice’ for paramedics

in Ontario and across Canada. The PAC’s Strategic Plan (2016‐2018) includes the following

objectives.

Completion of a new of a new Canadian Paramedic Profile (formally known as the National

Occupational Competency Profile).

Development of a Canadian Standards of Practice document.

Preliminary information indicates that this research may result in the following outcomes:

Narrowing of the gap between PCP and ACP competencies which, by extension, will impact

existing service delivery models.

ACP numbers may decrease, and they may be used exclusively for higher acuity

emergencies.

A broadening of clinical practice guidelines that would see paramedics interfacing more

frequently with other healthcare professionals in the delivery of care, and strengthening of

the community healthcare system.

Recommendation: Oxford County’s paramedic service operates at the Primary Care Paramedic

level (PCP). The paramedics are PCPs who also are certified by the Base Hospital to perform IV

starts. This standard is consistent with that of multiple EMS peers, particularly those serving



largely rural areas. In consideration of the ‘scope of practice’ research presently underway, we

recommend that OCPS maintain a PCP service level standard, and forego any consideration of

advancement to ACP, until the research is complete.

2.10 Ambulance Service Review (ASR)

Every ambulance service in Ontario must have a provincial operating certificate that is current.

To receive and maintain provincial certification, each land ambulance service operator must

undergo an Ambulance Service Review (ASR) every three years.

ASR’s are organized and managed by the MOHLTC Emergency Health Services Branch. The ASR

assesses the service provider relative to the legislation, regulations and standards; focusing

predominately on compliance and performance in the following three areas:

Patient care: to ensure that patient care is provided in accordance with the legislated

standards for Basic Life Support Patient Care and where applicable, the Advanced Life

Support Patient Care Standards.

Quality Assurance (QA): to ensure that the service provider has a QA program in place, to

ensure optimal provision of services, including: Ambulance Call Report (ACR) and field

performance audits; incident report audits; in‐service CME; and Base Hospital certification.

Also, that the QA program include investigations of patient care and service delivery

complaints, and recommendations to mitigate reoccurrence.

Administration: to ensure that the service provider has implemented plans, policy,

procedures, and insurance in conformance with the regulations and standards, including:

Response Time Performance Plan, Deployment Plan, Ambulance Service Identification

Cards, vehicle and equipment preventative maintenance, and Base Hospital Agreement.

Methods used to assess a service provider include: interviews with staff; ride‐outs; review of

pertinent files; and inspections of service vehicles, equipment, and supplies.

The MOHLTC Emergency Health Services Branch recently completed an ASR of Oxford County’s

land ambulance service. The Ministry’s findings, issued in an ASR Report dated February 21,

2017, affirms that the service successfully meets all legislated requirements for certification in

the Province of Ontario.

2.11 Provincial Funding

While each UTM / DDA is fully responsible for all costs associated with the provision of land

ambulance services in their service area, it is the MOHLTC’s practice to provide each UTM /

DDA with an annual grant equal to 50% of the approved cost of the land ambulance services

that they deliver.

In addition, MOHLTC pays 100% of the approved cost for ambulance services to First Nations,

and for CACC and Base Hospitals services.

In accordance with the above practices MOHLTC provides the County of Oxford with an annual

grant equal to 50% of the approved cost of the paramedic services that they deliver in the



geographic jurisdiction of the County. Each year’s grant is based on the previous year’s land

ambulance services costs.

2.12 Paramedic Response Unit

A Paramedic Response Unit (PRU) is a vehicle operated by one fully‐certified paramedic, in lieu

of a crew of two. The paramedic must be sufficiently experienced to work a medical emergency

on their own, while awaiting arrival of a transport capable ambulance. 4

PRU are intended to supplement ‐ not replace ‐ the core service provided by patient transport

capable ambulances. For paramedic services that utilize PRU, the principal features of the

arrangement include:

Operated by one fully‐certified paramedic in lieu of a crew of two

Operating with one paramedic in lieu of a crew of two, the operating cost per vehicle‐hour

is about one‐half that of an ambulance.

Vehicle is under management control of the paramedic service

Vehicle is part of the service fleet. Its role is defined in the service’s Deployment Plan.

Vehicle is dispatched by CACC

Has no patient transport capability. Patient transport to hospital is by ambulance.

Conforms to same policies and protocols as a fully‐outfitted ambulance

Delivers same level of paramedical skills/services, and is subject to the same rigorous QA

No different than other paramedic service add‐on’s, e.g.: bike‐medic / marine‐medic

PRU use varies depending on the service’s objectives. Below is a range of roles / uses:

May serve as EMS first responder

Enhances response time performance (stops the clock)

Calls off ambulances when patient transport is not required

Specialty team operations (Tactical Paramedics, Incident Response/Haz‐Mat).

OCPS, and many other Ontario land ambulance services, do not operate with PRU.

Recommendation: PRU are intended to supplement, not replace patient transport capable

ambulances. In consideration of the County’s rapidly escalating EMS service demand, which is

adversely impacting ambulance response time and workload (as discussed in subsequent

sections of this report), we recommend that enhancing core services by staffing additional

transport capable ambulances should be Oxford County’s near‐term priority.

2.13 Provincial Plans for Enhancement of Paramedic Services

Ontario’s health care system is progressively shifting care delivery from hospitals and long‐

term care facilities, to people’s homes and the community. Also changing is the role of the

4 A Paramedic Response Unit (PRU) is oftentimes also referred to as an Emergency Response Unit (ERU). In this document, the two terms have the same meaning.



Ontario paramedic, which is evolving and improving, in step with the provincial health care

system shift, to better meet outpatient care needs and improve patient outcomes.

On June 5th, 2017 MOHLTC announced that Ontario would be enhancing and modernizing its

emergency health services system to provide people with increased flexibility and more

options for medical transportation and paramedic services, to ensure they receive the right

care when they need it.

The proposed enhancements include investing in a new medical dispatch system that will

improve CACC’s triaging and prioritization of 911 calls for ambulance service. The new system,

which will replace the current “Dispatch Priority Card Index (DPCI)”:

Will better prioritize calls based on patient medical need.

Will continue to provide an immediate ambulance response to medical emergencies.

May redirect low acuity patients (i.e., those with non‐urgent need), in a timely and

convenient manner, to locations other than emergency departments, in instances where it

would be safe and appropriate to do so.

The new system is expected to be implemented at all provincial CACCs over the next 2 to 3

years.

The province also plans to change/update the Ambulance Act (1990) through a transparent and

inclusive consultation process, to ensure patients continue to receive the right care at the right

time.

The legislative change, if passed, will provide paramedics with increased flexibility to deliver

alternative care options on‐scene, by referring/transporting patients to non‐hospital options,

such as a primary or community‐based care facility, or a mental health facility.

Currently, paramedics are bound by law to transport patients to hospital facilities only. The

proposed change would allow patients to receive care appropriate to their needs, closer to

home and in the community, while improving ambulance service coverage and reducing

unnecessary trips/overcrowding in emergency departments.

The proposed legislative change, will also enable the government to provide funding for two

pilots in interested municipalities that will enable firefighters certified as paramedics to

respond to low acuity calls to treat and release or treat and refer a patient, and provide

symptom relief to high acuity calls.

The proposed legislative changes are set out in Bill 160, the “Strengthening Quality and

Accountability for Patients Act, 2017”. The Bill has passed second reading, and is presently

undergoing additional public and stakeholder consultations.



3 OCPS ORGANIZATIONAL REVIEW

3.1 Paramedic Services Pyramid

Exhibit 3.1 illustrates the extensive infrastructure required, to ensure a rapid ambulance

response to an emergency incident, with paramedic services of a high calibre. The exhibit is

configured in the form of a pyramid, using multiple layers to illustrate the main components.

The patient, and public‐at‐large, see only the tip of the pyramid i.e., an ambulance responding

swiftly, with flashing lights and siren.

They do not see the extensive underlying infrastructure needed by the organization, to

organize and effectively deliver the services, while fully adhering to: provincial legislation and

standards; Base Hospital standards; Corporate policies; and service levels and budgets

authorized by County Council.

The patient, and public‐at‐large, also do not see the extensive infrastructures of the province

and Base Hospital which monitor and assess the service to exacting standards; or the CACC,

which is responsible to dispatch a medical response to each incident using the closest available,

and most appropriate ambulance to meet the needs of the patient.

This section of our report reviews and assesses the infrastructure components of the Oxford

County Paramedic Service.

EXHIBIT 3.1: PARAMEDIC SERVICES PYRAMID



3.2 Organizational Structure

The OCPS organizational

structure is shown in Exhibit

3.2. The Service consists of:

Manager/Chief

2 Supervisor / Deputies

4 Platoon

Superintendents

Supervisor of EMS

Education

Coordinator of EMS

Logistics

Executive Assistant

52 full‐time and 36 part‐

time paramedics.

The paramedics are

represented by OPSEU Local

114. All other staff are

management excluded.

MANAGER/CHIEF OF PARAMEDIC SERVICES

On behalf of the Corporation, the Manager/Chief of Paramedic Services is responsible to plan,

organize, and ensure effective delivery of land ambulance services that fully comply with

provincial legislation, regulations and standards; and with service levels and budgets approved

by County Council. The Manager/Chief also serves as the organization’s principal liaison for

public and media relations.

The Manager/Chief of Paramedic Services reports to the Director, Public Health & Emergency

Services, and by way of the Director to the County’s Chief Administrative Officer.

SUPERVISOR/DEPUTY CHIEF, PARAMEDIC OPERATIONS & PERFORMANCE

The Supervisor/Deputy Chief, Paramedic Operations & Performance oversees the field

operations, ensuring: service continuity, consistency of delivered services, individual paramedic

staff performance, and accurate and complete patient care documentation, as required by

provincial regulations and standards.

To such ends, the incumbent’s duties include: operational planning; paramedic training and

education, and internal investigative and quality management programs that comply with

legislation and certification requirements.

The incumbent is assisted in these tasks by four (4) Platoon Superintendents and a Supervisor

of EMS Education.

EXHIBIT 3.2: OCPS ORGANIZATIONAL STRUCTURE



PLATOON SUPERINTENDENTS

The four (4) Platoon Superintendents are responsible to provide on‐duty field supervision on a

rotating basis, 24/7. To such ends, they work 12‐hour shifts, rotating in tandem with the

paramedics. Their main duties include:

Maintain shift schedule, taking necessary steps when needed, to fill short‐notice vacancies.

Random inspections to ensure operational readiness of fleet and that personnel assigned

to a shift report on time, fit for duty, properly attired, and aware of the safe, normal or

special requirements of each work assignment.

Patrol the service area. Monitor the availability of ambulance resources in cooperation

with the CACC.

When on scene, they will assess paramedic work performance; also, provide guidance,

assistance, and discipline as necessary.

They will also ensure that paramedics are observing operational policies, and Occupational

Health and Safety (OH&S) practices, during their shifts.

May respond to a medical emergency, and coordinate/direct activities of personnel and

equipment.

Available as needed, to support/mentor paramedic staff; also, to attend an injured

paramedic. In the case of a paramedic injury, they will either upstaff or fill in on a short‐

term basis, and conduct an OH&S inspection.

Ensure that paramedics complete all requisite reports, including: Ambulance Call Reports

(ACR), Incident Reports, and Vehicle Accident Reports.

Perform/assist with investigations, and help respond to complaints.

SUPERVISOR OF EMS EDUCATION

The Supervisor of EMS Education works with Platoon Superintendents and others, to deliver

training, and to assess and enhance medical care through point of contact quality review, and

education interventions – this, to assist in service wide, group and individual employee

development. Specific duties include:

Develop and deliver in‐service training and education programs, including service specific

Continuing Medical Education (CME), return‐to‐practice training, and remedial education.

Work with the Southwestern Ontario Regional Base Hospital Program and area colleges to

provide external training and education.

Perform in‐service field evaluations, periodic performance audits, and annual appraisals of

paramedic staff members. Also, coordinate external performance audits and paramedic

certification by the Base Hospital.

Maintain relevant records pertaining to paramedic education, work performance and

certification.



Community and allied agency relations, actively participating in structured collaborations,

peer support training, and Community Paramedicine initiatives involving police and fire

first responders, community‐based health agencies, and government institutions.

SUPERVISOR/DEPUTY CHIEF, LOGISTICS & STANDARDS

The Supervisor/Deputy Chief, Logistics & Standards is responsible for essential, in‐service

support functions that the organization relies upon for consistent delivery of high calibre

paramedic services, such as those listed below.

In‐service management and maintenance of fleet and equipment. Inventory management

and secure storage of paramedic supplies and medications. Ensuring that relevant

documentation and files are prepared and maintained in a manner that complies rigidly

with provincial regulations.

Design and management of a paramedic master schedule that fulfills the requirements of

the operational deployment plan, making sure that shifts are appropriately staffed by full‐

time and part‐time paramedics in accordance with terms of the collective agreement, staff

availability, and departmental policy.

Administration of attendance records, to ensure accurate and timely processing of

employee pay.

Proactive participation, as management member, in Joint Occupational Health and Safety

Committee. Coordinate condition appraisals / repairs of EMS facilities with Corporate

Public Works.

The incumbent is supported in these essential responsibilities by a Coordinator of EMS

Logistics, and they are frequently assisted by Platoon Superintendents, the department’s

Executive Assistant, and others.

COORDINATOR OF EMS LOGISTICS

In concert with the Supervisor/Deputy Chief, the Coordinator of EMS Logistics performs the

daily duties that are required to administrate the paramedic schedule, and to manage and

maintain the fleet, equipment and supply assets, according to departmental policy, and

legislative regulations.

The incumbent is a seasoned veteran with many years of experience in EMS operations and

logistics support services. As Coordinator of EMS Logistics, the incumbent maintains excellent

relations not only within the department, but also with external suppliers and vendors, and

with EMS peers, who frequently call on him for EMS Logistics advice.

PARAMEDICS

The Service employs 52 full‐time and 36 part‐time paramedics who are assigned to

ambulances, in teams of two per vehicle, for shifts which are generally of 12‐hour duration;

this, per the industry norm.

When ambulance shifts are scheduled, full‐time paramedics are first to be assigned. Part‐time

paramedics are scheduled as needed to backfill for vacation, sick leave, and other absences as



may occasionally arise. Use of part‐time employees for backfill is common practice within the

industry.

Oxford County paramedics are trained to the Primary Care Paramedic level (PCP). They also are

certified by the Base Hospital to perform IV starts. The standard is consistent with that of

multiple EMS peers, particularly those serving largely rural areas.

CORPORATE SUPPORT

The Service receives professional support from other areas of the Corporation, as and when

required. Support services include financial planning, facilities management, IT, legal, and

human resources support.

3.3 Field Supervision

The duties of a Platoon Superintendent, as described in Section 3.2 above, are integral to

ensuring service quality, paramedic work performance, and staff’s compliance to Occupational

Health and Safety (OH&S) practices.

Industry leading (best) practices for EMS services of comparable size, recommend that there

should always be at least 1 Platoon Superintendent on duty, to carry out these essential

functions.

OCPS employs 4 Platoon Superintendents, and by having them serve on a rotating basis, the

service should be able to sustain the above noted best practice coverage level. This

notwithstanding, we find that:

On day shifts, field supervision is limited, with Platoon Superintendents spending time at

headquarters (Mill Street) dealing with administration, investigations, helping with supplies

management, and working on special projects – albeit, for urgent matters, they are

accessible by telephone.

On night shifts, in‐the‐field interaction with paramedics is virtually non‐existent. This

situation exists because Platoon Superintendents are required by County policy, to staff

ambulances at night.

To relieve Platoon Superintendents of some of their workload, OCPS has trialled a solution,

whereby a paramedic serving as Platoon Leader is assigned to accompany Platoon

Superintendents on a rotating basis. This approach however, is severely constrained, since the

paramedic’s primary responsibility is to staff an ambulance during their on‐duty shifts, and

they are only available to assist the Platoon Superintendent when not deployed to a call.

In our opinion the County’s policy requiring Platoon Superintendents to staff ambulances is

inconsistent with practices adopted by most other paramedic services of comparable size, and

larger, and it should be changed for the reasons listed below.

At night, the policy adversely impacts both in‐the‐field supervision and the staffing

coverage provided by the Mill Street ambulance (i.e., the ambulance staffed by the on‐duty

Platoon Superintendent) since, that Platoon Superintendent cannot be available to

respond to the next medical emergency if they, in their capacity as field supervisor, are



already busy assisting on a call elsewhere. Similarly, the Platoon Superintendent cannot

serve as field supervisor to assist a paramedic crew, if they’re already dispatched to their

own medical emergency.

When such circumstances arise, a rural‐based ambulance is typically dispatched to an

urban area, to maintain coverage or to respond to a call. This practice has adversely

impacted both ambulance availability in the rural townships and the workload of rural

ambulances which, as discussed in subsequent sections of this report, has increased to

levels that exceed industry standards.

The situation is exacerbated by the deployment of fewer ambulances at night. Night‐time

coverage is 6 staffed ambulances, dropping to 5 between 02:00 and 06:00 hours. In

comparison, daytime coverage peaks at 8 staffed ambulances on weekdays, and at 7

staffed ambulances on weekends.

OCPS advises that, over the 6 months May to October 2017, London CACC signaled Code

Critical Status 238 times, i.e., in these instances there were 3 or fewer ambulances

available to respond to emergency calls. Sixty‐six percent (66%) of these occurrences were

during the night shift.

Recommendation: The County’s policy requiring Platoon Superintendents to staff ambulances

at night, is inconsistent with practices adopted by most other paramedic services of

comparable size, and larger. We recommend that this policy should be eliminated, and the

service should recruit 2 additional full‐time paramedics to fill the night‐time ambulance shifts,

in lieu of the Platoon Superintendents. 5

By implementing this recommendation, Platoon Superintendents will be better able to

manage: Health & Safety I WSIB supervision and enforcement requirements; emergency

incident command; and CACC’s deployment of the County’s ambulance resources, including

ambulance offload delay at hospitals, out‐of‐County ambulance responses, and balanced

emergency coverage. Platoon Superintendents will also be better able to support paramedic

staff in‐the‐field, i.e., to perform field evaluations, mentoring/coaching and when needed, to

assess/address the paramedic’s physical and mental wellness. This change will also increase

unit availability, and provide better urban‐rural demand and workload balance.

3.4 Paramedic Training & Education

Duties that the Supervisor of EMS Education is responsible to perform, were presented

previously in Section 3.2. In our opinion, the duties are being performed as set out.

Each medic receives 24 hours of CME annually. This is delivered by way of two in‐service

sessions (one in spring and another in the fall), and one fall session organized by the Base

Hospital. All sessions are of 8 hours duration.

5 Oxford County Council implemented this change on December 18, 2017 as part of its 2018 budget deliberations. The full-time and part-time paramedic complements reported in this document reflect this change.



Annual CPR refreshers are incorporated into one of the in‐service CME sessions. In addition,

OCPS hosts a “Centre for Learning” website, which provides paramedics with information

updates on new equipment and processes.

MOHLTC Land Ambulance Certification Standards require that service providers take all

reasonable measures to ensure that each paramedic in their employ, is competent in the use of

the patient care, and communications equipment, required for the proper provision of service

in accordance with the Basic Life Support and Advanced Life Support Patient Care Standards.

OCPS’ Paramedic Training and Education program was reviewed by the MOHLTC’s recent ASR.

Below is what the ASR reported.

The service ensures that paramedics have access to:

Current user guides

Training bulletins

Videos and mandatory learning materials

A medium for the review of training materials

Base Hospital training

Base Hospital Policies and Protocols.

The service has processes in place to ensure that paramedic knowledge and skills are

maintained. They include:

Annual aggregate evaluation of compliance with Patient Care Standards.

Evaluation results communicated to staff.

New staff members undergo an evaluation of their patient care skills.

A remedial training program for staff who demonstrated deficiencies in the use of patient

care equipment.

Training for new, updated and additional equipment.

The service works to ensure that each paramedic is competent in the use of patient care

equipment. Also, the service works with the Base Hospital to:

Ensure staff regularly demonstrate proficiency in patient care skills, and in performing

Controlled Acts.

Provide remedial training to employees whose patient care skills are considered deficient,

or whose certification has been suspended.

Ensure Base Hospital certification is on file.

3.5 Quality Assurance

Every land ambulance service delivery agent in Ontario is responsible for the proper provision

of land ambulance services, and quality patient care, in compliance with provincial legislation,

regulations and standards. Further, every land ambulance service in Ontario is required to

establish and maintain a comprehensive, in‐service Quality Assurance (QA) oversight program.

The MOHLTC’s recent ASR (2017) affirms that OCPS maintains a QA program to ensure optimal

provision of the services.



The QA program includes: ACR and field performance audits; Incident report audits; In‐service

CME; and Base Hospital certification. The QA program also includes investigations of patient

care and service delivery complaints, and analysis and recommendations to mitigate

reoccurrence.

Presented below is a typical ‘Quality Assurance’ program portfolio. In our opinion, OCPS

performs these functions largely as set out.

Track operational performance using Key Performance Indicators (KPI). Assess KPI trends

and major variances, including cause and means for their management (e.g., urgent and

non‐urgent call volume, response time, standby volume, hospital off load delay, hospital

transfers, code red, staff O/T, and staff uploading).

Ensure that every paramedic participates in the requisite in‐service and Base Hospital

Continuing Medical Education (CME).

Perform internal investigations, engaging management, staff, stakeholders and MOHLTC as

appropriate. Analyze issues to identify cause and effect, and areas for improvement,

including internal process adjustments. Prepare recommendations and reports.

Communicate findings to appropriate parties.

Ensure that paramedics prepare incident reports as required by MOHLTC Ambulance

Documentation Standards.

Review and assess incident reports. Submit a copy of the incident report to MOHLTC,

within the Ministry’s prescribed timetable, and communicate findings to appropriate

parties.

Perform Ambulance Call Report (ACR) audits, ensuring that an ACR has been prepared for

every medical call. Using sample sizes established by service policy, review a sample of

ACRs focusing on the patient’s needs and care provided by paramedics. Also, facilitate

Base Hospital audit of ACRs involving high acuity calls.

Perform Field Audits, and assess paramedic staff performance.

Ensure internal processes for ACR and Field Audits including: review, evaluate, inform,

follow up, and remediation where warranted. Prepare and share an ACR compliance

report with each staff, at least once a year.

Perform an annual review / audit of each employee’s files for certification relative to

MOHLTC requirements. Coordinate with Corporate HR on matters relating to: Worker

safety programs (Ebola training, WHMIS certificates, etc); Personal Health Information

Protection Act (PHIPA); and Municipal Freedom of Information and Protection of Privacy

Act (MFIPPA).

3.6 Fleet and Equipment Management

Fleet and equipment management refers to all functions pertaining to the management of fleet

and on‐board equipment on a consistent basis, including regularly scheduled preventative



vehicle maintenance, unscheduled repairs, and maintaining all related documents in

accordance with legislative requirements, as listed below. 6 7

Coordinate “in‐service” management and maintenance of fleet, equipment, and supply

assets, for the efficient and effective delivery of paramedic services. Administrate these

essential support services in the manner prescribed by departmental policy, to ensure

compliance with the provincial Ambulance Act, Regulations and Standards.

Make sure that vehicles are regularly cleaned, checked, and stocked for shift changes and

that deep cleans are performed as scheduled, and as circumstances require, in accordance

with MOHLTC requirements. Also, ensure that documentation for same is maintained in

accordance with MOHLTC requirements.

Coordinate regularly scheduled preventive vehicle maintenance, service, and repairs, in

accordance with MOHLTC requirements. Ensure related documentation and files are

maintained in accordance with legislation.

Coordinate regular cleaning and preventive maintenance of equipment (e.g., stretchers,

stair chairs, defibrillators, oxygen and suction equipment, radios, chargers, battery

recharge/replacement). Maintain documentation of same in accordance with legislative

requirements.

Perform quality inspections of the work of staff, audit documentation, and arrange

training, as required. Provide quality assurance support to improve related processes and

procedures, ensure legislative requirements, and maximize resource availability.

Determine inspection schedule for stretchers, stair chairs, defibrillators, communications

devices, and other major equipment based on use. Arrange servicing and repairs with

contractors or MOHLTC, and order replacement parts as required.

Coordinate replacement of end‐of‐life vehicles and equipment. Ensure related

documentation and files are maintained in accordance with legislation.

Regularly scheduled preventative maintenance of ambulances is set out in departmental

policy. The policy is based on standards originally established by MOHLTC, and is consistent

with industry leading practices, and those adopted by EMS peers.

By policy, each crew visually inspects their vehicle at the start of shift, and they clean their

vehicle and replenish on‐board supplies at end of shift. Crews perform a deep cleaning of

vehicles and on‐board equipment once a week, and they notify Logistics of any needed repairs.

Preventative maintenance of ambulances is performed at intervals of about 10,000, 20,000 and

40,000 km, which generally correspond to a 90‐day, semi‐annual, and annual timeframe. 8

6 Except for on-board radio communications equipment. Management of this equipment is MOHLTC’s responsibility.

7 On-board major equipment includes stretchers, stair chairs, defibrillators, oxygen and suction equipment. 8 The industry commonly refers to this preventative maintenance schedule as the A, B and C inspections.



Fleet maintenance and repairs are contracted to external vendors. For ambulances, and for

the GM and Toyota command vehicles, OCPS uses the services of Gord Anderson Automotive

Group, in Woodstock, who generally arranges ambulance pickup and return. The International

truck is maintained by the Carrier Truck Center in Brantford. Tires for fleet vehicles are

purchased from Al’s Tirecraft Auto Center, in Ingersoll.

OCPS is pleased with the services provided by the external vendors, which they describe to be

responsive and thorough.

MOHLTC’s recent ASR (2017) reviewed OCPS’ practices with respect to fleet and equipment

management, and commended the service, as below.

Ambulances are constructed and equipped in accordance with provincial standards.

OCPS rigorously adheres to a vehicle and equipment cleaning/deep cleaning program that

aligns to standards.

OCPS rigorously adheres to a preventative maintenance program and schedule, for vehicle

and equipment maintenance, which aligns to standards.

Vehicles and equipment are maintained to the manufacturer’s specifications.

Equipment is maintained to standards, in a clean and sanitary condition.

Repairs or replacements are completed in a timely manner.

OCPS rigorously maintains comprehensive records for the management of vehicles and

equipment, and supplies inventory, in accordance with provincial standards.

The record keeping process includes oversight and audit for completeness, accuracy and

safety.

APEXPRO concurs with the ASR findings. In our opinion, the two incumbents responsible for

fleet and equipment management (i.e., Supervisor/Deputy and Coordinator of EMS Logistics),

carry out the services diligently. The procedures used are well‐configured, and the services are

carried out in a manner that conforms with provincial regulations and industry standards; this,

as should be the case, since the incumbent(s) are recognized by EMS peers across Ontario for

their experience, and are frequently called for EMS Logistics advice.

OCPS stakeholders support APEXPRO’s findings. They too are of the view that fleet and

equipment management services are being carried out diligently, and efficiently.

However, in their opinion, additional Logistics staff are needed to handle the current workload,

which involves not only fleet and equipment management; but also supply asset management

(discussed below in Section 3.7), scheduling/payroll, and recurring special projects which are

related to these functions, i.e., vehicle and equipment tendering, Health and Safety, changes in

scheduling software, Logistics practices research and development, etc.

Currently, to fulfill these essential responsibilities, the incumbents must frequently request

assistance from Platoon Superintendents, the department’s Executive Assistant, and others.



APEXPRO concurs with the above noted stakeholders’ opinion; additional Logistics staff are

needed to handle the combined workload (as recommended in Section 3.7 below).

3.7 Supply Asset Management

Supply Asset Management refers to functions such as those listed below. In our opinion, OCPS

performs these functions largely as set out. The procedures are well‐configured, and the

services are being carried out in a manner that conforms with provincial regulations.

Set, manage and maintain supply inventory at appropriate levels. Also manage

procurement of uniforms. Coordinate purchasing with Corporate Finance, and manage

records.

Coordinate the acquisition of medications with the contracted pharmacy. Oversee

medication / supply management system to maintain stock levels, manage inventory and

distribution, maintain documentation, and provide technical support as needed.

Securely manage the supply of controlled medication/narcotics, to ensure secure storage,

distribution, and documentation of usage, in accordance with legislative requirements.

Ensure related documentation and files are maintained in accordance with legislation.

All OCPS stations are supplied by the main stores, located on the lower level of the

Headquarters facility at 377 Mill Street, Woodstock. The process is described briefly below.

Paramedics based at station perform an inventory count, each week, entering the

information directly into the Operative IQ supplies inventory management system.

The Operative IQ system uses the count information in conjunction with historical rates of

supplies depletion, to determine each base’s replenishment requirements.

Coordinator of EMS Logistics reviews each base’s replenishment requirements, checking

for consistency of pattern and major variances which may require follow up. They draw

the requisite supplies from the main stores, and organize each base’s shipment.

Shortly thereafter, the supply package is picked up and delivered at base by an on‐duty

Platoon Superintendent.

The entire process, from inventory/requisition to delivery, typically takes less than 24

hours to complete.

The above process notwithstanding, a vehicle or station may occasionally be depleted of an

asset, requiring the paramedics, or on‐duty Platoon Superintendent, to secure a replacement,

from another station or main stores.

The Coordinator of EMS Logistics, reviews supply inventory levels at the main stores on a

weekly basis. They reconcile the supply inventory numbers; and using Operative IQ, they

requisition the replenishment of main stores’ supplies from external vendors. On receipt of

delivery, the Operative IQ records are updated. A thorough reconciliation of supply asset

inventory is performed bi‐annually.



Within OCPS, the Supervisor/Deputy Chief, Logistics & Standards, is responsible for the

essential, in‐service Logistics support functions that the organization relies upon for consistent

delivery of high calibre paramedic services.

The incumbent is supported in these essential responsibilities by a Coordinator of EMS

Logistics, and because the workload exceeds their combined capacity, they frequently must

request assistance from Platoon Superintendents, the department’s Executive Assistant, and

others.

OCPS stakeholders are of the view that additional Logistics staff are needed to handle the

combined workload. APEXPRO concurs, drawing supporting data from EMS peers of similar or

slightly larger size (Cornwall, Lambton, Peterborough and Frontenac). As shown in Exhibit 6.4,

the peers resource the Logistics support function with larger numbers of staff.

Recommendation: We recommend that OCPS should increase Logistics staffing by a minimum

of 0.5 FTE. This will not only reduce Logistics’ reliance on other areas of the organization, but

also better align the Logistics staffing level to that of comparable EMS services (as shown in

Section 6 of this report).

3.8 Scheduling & Payroll

Scheduling & payroll refers to functions such as those listed below. In our opinion, OCPS

performs these functions largely as set out.

Design and implement a paramedic master schedule that fulfills the requirements of the

operational deployment plan.

Ensure that shifts are appropriately staffed by full‐time and part‐time paramedics in

accordance with terms of the collective agreement, staff availability, and departmental

policy.

Manage day‐to‐day scheduling, ensuring that shift change and time off requests, are

addressed in a timely manner.

Audit attendance, and ensure accurate and timely processing of employee pay.

The paramedic master schedule, consisting of full‐time and part‐time paramedic shift

assignments, is updated three times a year, for the following intervals: Feb 1 – May 31; June 1

– Sept 30; and Oct 1 – Jan 31.

The process is relatively straightforward. About 6 weeks in advance of the interval, staff are

asked to submit their requests and availability. The requests are reviewed relative to the

collective agreement and departmental policy, and a master plan is established. The target for

posting an updated plan is 3 weeks prior to the start of the interval.

Paramedics may submit shift change and time off requests at any time, for such purposes using

an on‐line Jacobs Business Software (JBS) scheduling software system. Management, assisted

by the department’s Executive Assistant, uses the JBS information to track vacation, sick days,

shift changes, and time off; and to ensure timely processing of employee pay.



3.9 EMS Administrative Support

An Executive Assistant, reporting to the Manager/Chief of Paramedic Services, fulfills the

administrative support requirements of the department. Having worked in the service for

many years, the incumbent is fully versed in the responsibilities and duties of the position, and

carries them out diligently. The main functions carried out by the incumbent are listed below:

Provide administrative support for the day‐to‐day operations, quality assurance, training,

and ambulance certification.

Perform secretarial/administrative duties for the Manager/Chief and others, including:

handle incoming mail, routine correspondence, assist with reports, coordinate meetings,

schedule interviews, manage purchase orders, order supplies and update Operative IQ

records.

Perform payroll duties using Jacobs Business Software (JBS) to track vacation, sick days,

shift changes, and time off. Ensure that proper payroll information is forwarded to

Corporate Finance.

Manage confidential personnel files (e.g., for certification, WSIB and performance

appraisals), ensuring that employee information is up‐to‐date, scanned and uploaded into

the correct HRI file. Forward required documents to Corporate HR.

Manage other confidential correspondence and reports, including: Incident Reports, call

logs, Base Hospital ACR evaluations, etc. Ensure that the information is appropriately filed

and distributed to relevant parties.

In support of senior management, manage requests for confidential information by

external parties, including lawyers and insurance companies.

Keep track of accounts payable and accounts receivable. Coordinate as necessary with

Corporate Finance.

Manage employees that are assigned to administrative work while on light duty

assignment.

Provide reception services. Receive deliveries. Greets guests. Answers telephone calls.

Respond to general inquiries. Take messages and refers calls to appropriate staff.

Recommendation: The incumbent has expressed a desire to take on increased responsibilities

on behalf of the Service. We recommend that the incumbent be assigned responsibility for

managing shift change and time off requests ‐ this, in addition to the support they currently

provide in ensuring timely processing of employee pay. Administrative Assistants in other EMS

organizations have already assumed similar scheduling‐related responsibilities. 9

9 Following initial finding discussions, OCPS implemented this recommendation in late 2017.



3.10 IT Systems Support

Below are abbreviated descriptions of several IT systems used by OCPS. Similar systems are

used by EMS peers across Ontario.

AMBULANCE DISPATCH REPORTING SYSTEM (ADRS)

The Ambulance Dispatch Reporting System (ADRS) is a primary source of information for

assessing land ambulance service performance, the effectiveness of deployment plans,

resourcing needs, and funding requirements.

ADRS is a database managed by MOHLTC, which contains pertinent details of each call for EMS

assistance, and each ambulance response dispatched by CACCs across Ontario. Pertinent

call/ambulance response details housed by ADRS, include: date, time call received, dispatched

priority, vehicle and station dispatched, time of ambulance’s arrival scene, time spent on scene,

transport time to hospital, time to transfer of care at hospital, and time call cleared.

MOHLTC provides each UTM/DDA with access to ADRS incident records for their

service/service area. Until recently, the Ministry would issue an information update by way of

a data disk/memory stick, at intervals of 6 to 12 months. The data was usually 6 months in

arrears – hence the reason that the analysis contained within this report is based on data for

2016 and prior years.

With the recent release of ADRS V1.5, each UTM/DDA can now access their data by way of a

provincially hosted server (i.e., periodic distribution of memory sticks is no longer

required). Moreover, the data is current to within a few days, and each UTM/DDA has access

to a consistent dashboard of software enquiries (also hosted on the server), which can be used

to generate relevant ambulance response profiles.

ELECTRONIC AMBULANCE CALL REPORTING (e‐ACR)

Provincial regulations require that paramedics complete a record of each call involving a

patient. These are called Ambulance Call Reports (ACR) or Patient Call Reports (PCR). Both

have the same meaning.

ACR records differs from ADRS in that the ACR database records detailed information on the

patient’s medical issue and the treatment that the paramedic provided. The database can be

used to assess the quality and consistency of paramedic work performance for each individual

call, by trend, by paramedic, etc.

For purposes of quality management, services are required to review each ACR record for

completeness. Services also are required to audit a sample of ACR records for details on the

care provided. Base Hospitals are required to audit ACRs involving high acuity calls.

ACRs used to be prepared manually. Several years back the process was computerized, with

each service selecting an IT system from one of several vendors (i.e., Zoll, I‐Medic, or other).

Using such systems, paramedics record information into a software application housed on a

tablet/laptop, and the information is uploaded into a database located on a server, which can

either be maintained by the service, or by the vendor on behalf of the service. The auditing



process has also been facilitated by the vendors’ advent of dashboard‐based software

enquiries.

OCPS has used an e‐ACR system manufactured by Zoll for a number of years, and the system

has performed as expected. This notwithstanding, OCPS has recently completed a review of all

leading‐edge options, focusing mainly on their respective dashboard software analytics

capability. OCPS plans to transition to an alternative system in early 2018.

OPERATIVE IQ

OCPS manages its fleet, equipment and supply assets, using a proven software system known

as Operative IQ. The Operative IQ system is also used by many other EMS peers.

According to users, the system is well‐configured for such functions, as listed below:

Scheduling and tracking maintenance and repair of fleet and equipment;

Inventory, procurement and replenishment of supplies; and

Managing documentation, as may be required by provincial regulation.

The above notwithstanding, other than medications which OCPS purchases directly from

pharmaceuticals, most supplies are purchased on behalf of OCPS by Oxford County’s Finance

Department ‐ this being the general practice for all departments across the County; and the

Finance Department has established a robust software system for such purposes.

Operative IQ and the software system used by the Finance Department, are separate stand‐

alone systems, and as a result the procurement process involves some duplication of efforts

vis‐à‐vis the transference of purchase orders. To facilitate the process, it would be helpful to

look at alternate means for transference of the data.

SCHEDULING & PAYROLL

OCPS uses the Jacobs Business Software (JBS) system for scheduling shifts, and processing

employee payroll. They have used this proven system for many years and are fully conversant

with its capabilities.

Similarly, many other EMS peers have at one time or another, also used the JBS system for such

purposes.

The Corporation of Oxford County has decided to implement a County‐wide payroll

management system, for use consistently by all County departments. OCPS, as a County

department, will have to transition to the new system.

This change is not unique to Oxford County or to OCPS. Many other Ontario municipalities

have implemented a similar change. With care and appropriate planning, the transition can be

executed seamlessly.

WIFI & INTERNET

The service relies on internet/WiFi at base, and WiFi in vehicles, for dispatch, essential

communications and for processing of reports, e.g.:



For a medical emergency requiring a protocol decision, the paramedic may have to

communicate with the Medical Director, or ER physician, and they may also have to

simultaneously transmit supporting data electronically (e.g., ECG data to support a stemi

by‐pass protocol decision).

While most e‐ACR information is captured on‐site by way of a tablet, the paramedic must

also enter key call details from off the dispatch logs transmitted by CACC. The service also

relies on effective wireless communications for such purposes.

Overall, the internet and WiFi systems work well; however, periodically a situation will arise

where either system does not perform as would otherwise be expected. Such an occurrence

may arise from something as simple as incompatible on‐board vehicle technology which, when

identified, can be addressed relatively swiftly. Alternatively, the occurrence may result from a

gap in wireless geographic coverage, which may require a longer‐term Corporate, rather than

departmental, solution.

3.11 Performance Analytics

Performance analytics refers to analytical support functions that should be carried out on a

regular basis, to provide OCPS management with current information, on which to periodically

assess, and with Council’s support, realign (improve) the front‐line operations, supporting

services, and quality improvement processes and procedures. These would include:

Extraction, analysis and interpretation of EMS operations‐related statistical data.

Peer benchmarking of internal supporting services and procedures, and technology use.

Establish and track Key Performance Indicators (KPI) for quality and risk management.

Research and special projects, i.e., to investigate Community Paramedicine, Telehealth and

other innovative strategies for maintaining service excellence, while also slowing down

future EMS cost escalation.

In APEXPRO’s opinion there is no internal capacity within the OCPS organization to proactively

perform such functions, on an ongoing basis; and such analyses are undertaken only when

specifically requested, i.e., in response to a request for information by Council. Moreover,

when the information is requested, the analysis generally falls to the Chief/Manager of OCPS,

who must undertake the analysis in addition to their other pressing responsibilities.

Options available to OCPS include:

a) To maintain the status quo. APEXPRO does not endorse this option.

b) To secure analytic support from Corporate Services, or from a peer EMS organization.

APEXPRO does not endorse these options because, in our view, the operations‐related

analytic support required by OCPS differs significantly from the analytic support needs of

these other departments.



c) To secure analytic support from within the Health Department, as was the case in

Waterloo Region, where Waterloo Regional EMS shared a Health Data Analyst resource

employed by the Regional Health Department.

APEXPRO does not endorse this option because of the imminent replacement of the

County’s Health Department with a single health unit serving both Oxford County and Elgin

St. Thomas (as recently approved by County Council on January 10, 2018). In our view, the

operations‐related analytic support required by OCPS is likely to differ from the analytic

support needs of this new unit. Further, we understand that the new health unit will

operate as a separate, autonomous entity, which in our view is an additional complication.

d) To recruit a Performance Analyst as an OCPS resource. APEXPRO recommends this option.

Recommendation: A Performance Analyst should be recruited as a full‐time OCPS resource.

The incumbent will assemble, assess and provide OCPS management with EMS operations‐

related statistical data that will be used to improve the services.

The incumbent will also be responsible to establish and track Key Performance Indicators (KPI)

pertaining to OCPS’ participation in the CREMS Community Paramedicine program; and to

periodically carry out investigations, e.g., research into additional Community Paramedicine

programs for Oxford County.



4 EMS INFRASTRUCTURE & SUPPORT

4.1 EMS Facilities

As shown previously in Exhibit 1.1, Oxford County Paramedic Services (OCPS) resources are

strategically stationed throughout the County, taking into consideration the geographic areas

of highest EMS call concentration, optimum land ambulance coverage and response time.

The City of Woodstock, which is the largest population centre in the County and generates the

highest EMS call volume ‐ twice that of Tillsonburg and almost 4 times that of Ingersoll ‐ is

served by 2 ambulance stations and 4 ambulances.

The Towns of Ingersoll and Tillsonburg, and Norwich Township, are each served by 1

ambulance station and 2 ambulances. The Township of Blandford‐Blenheim is served by 1

ambulance based in Drumbo; and the Townships of Zorra and East Zorra‐Tavistock are served

by an ambulance stationed at Embro.

00 Mill, Woodstock 01 Bysham, Woodstock 02 Ingersoll 03 Tillsonburg 04 Norwich 05 Drumbo, Blandford‐Blenheim 07 Embro, Zorra

2 ambulances 2 ambulances 2 ambulances 2 ambulances 2 ambulances 1 ambulance 1 ambulance

APEXPRO conducted a visual appraisal of the facilities, and have determined that the stations

are suitable for EMS operations. Their condition is generally decent, with no identified major

structural/mechanical issues. The bases appear to be appropriately located with reasonable

access by road. Each station is discussed briefly below.

BASE # 00 – 377 MILL ST., WOODSTOCK

Constructed in 2012, the Mill Street base is the paramedic

service’s main headquarters. 10

It is a free‐standing, 2‐storey building which houses

administrative offices, meeting room, Superintendent’s

office, paramedic lounge, change rooms, training room,

and stores.

There also are 2 garages with a combined capacity to

house 7 vehicles. Vehicles stationed at this base include: 2

ambulances, 4 command vehicles, and an emergency

support unit (ESU).

10 Construction dates were provided by OCPS management.



Situated close to the Woodstock General Hospital, and equipped with a backup generator, this

facility also serves as backup Emergency Operations Centre (EOC) for Oxford County.

BASE # 01 – 208 BYSHAM PARK DR., WOODSTOCK

The Bysham base, in Woodstock, is a free‐standing, single‐

storey building with a double garage, which houses 2

ambulances.

The main features include: paramedic lounge, kitchenette,

small office, lockers, and supply cabinets.

Constructed in 1991, this base is the 2nd oldest in the OCPS

service. Overall, the condition of the base is decent, with

no readily identifiable structural/mechanical issues. There

are however, periodic difficulties maintaining a reliable

internet / WiFi connection.

BASE # 02 – 162 CARNEGIE ST., INGERSOLL

The Ingersoll base is of similar construction to Bysham.

It is a free‐standing, single‐storey building with a double

garage, which houses 2 ambulances. The main features

include: paramedic lounge, kitchenette, small office,

lockers, and supply cabinets.

Constructed in 1988, this base is the oldest in the OCPS

service. Overall, the condition of the base is decent, with

no readily identifiable structural/mechanical issues.

BASE # 03 – 81 KING ST., TILLSONBURG

The Tillsonburg base was constructed in 2008. It is a free‐

standing, single‐storey building with a 4‐bay garage, of

which 3 are drive through.

Vehicles stationed at this base include: 2 ambulances and

an event trailer.

The facility houses: a combined paramedic lounge, office

and kitchenette; lockers; and supply cabinets. It also is

equipped with a backup generator.

The facility is situated adjacent to police and fire, on a

local road with good east‐west access.

The condition of the base is decent; albeit, maintaining a reliable WiFi connection is difficult.



BASE # 04 – 6 TIDEY ST., NORWICH

The Norwich base, constructed in 2006, is a free‐standing,

single‐storey building with a double garage, which houses

2 ambulances.

One garage bay is a drive through; albeit, the driveway to

the back door has a steep slope, and ices up in the winter.

The facility features: a combined paramedic lounge, office

and kitchenette; lockers; and supply cabinets. It also is

equipped with a backup generator.

Overall, the condition of the base is decent; albeit, both

cellular coverage and WiFi are occasionally unreliable.

BASE # 05 (DRUMBO) – 895939 OXFORD ROAD 3, BLANDFORD‐BLENHEIM

The Drumbo base is a relatively small, single bay

ambulance station situated as an end unit of a County

Public Works building.

It houses 1 ambulance, and features a small lounge,

kitchenette, office and supply cabinets.

The base was constructed in 2005. The condition of the

base is decent; albeit, internet reception is occasionally

unreliable.

BASE # 07 (EMBRO) – 884135 ROAD 88, ZORRA TWP

The Embro base, also constructed in 2005, is of a similar

footprint to that of Drumbo, which was discussed above.

It is a relatively small, single bay ambulance station

situated as an end unit of a County Public Works building.

The station houses 1 ambulance, and features a small

lounge, kitchenette, office and supply cabinets.

The condition of the base is decent; albeit, internet

reception is occasionally unreliable.

4.2 EMS Fleet

The Service operates with 12 single stretcher ambulances. All are manufactured by Crestline

Coach. The Service also operates with 4 command vehicles ‐ a GM Tahoe; ¾ ton, modified GM

pickup; Toyota pickup; and an International truck.

Fleet vehicles are decommissioned on a 6‐year cycle. This practice is consistent with the

industry norm, which ranges between 5 and 7 years.



OCPS ambulances have traditionally been powered by diesel fuel. This practice is also

consistent with many EMS services. However, as it has become increasingly difficult to procure

a diesel ambulance chassis, and considering increasing concerns over diesel emissions, many

Ontario EMS services are transitioning their ambulance fleets from diesel to gas.

In lieu of this approach, Oxford County has decided to pursue a made‐in‐Oxford solution, which

is intended to support both the needs of its paramedic service as well as its corporate objective

aimed at reducing the County’s greenhouse gas emissions.

Specifically, in September 2017, the County replaced two end‐of‐life diesel ambulances with

two new Crestline Coach Fleetmax XL3 hybrid (electric/gas) ambulances. These are Canada’s

first hybrid‐model ambulances.

The XL3 hybrid, which uses regenerative braking to increase fuel economy and reduce fuel

costs, is outfitted with Ferno AceTech solar panels, which charge the on‐board batteries and

electrical systems, and with AceTech’s patented Eco‐Run anti‐idling system, which provides the

on‐board equipment and vehicle temperature controls with a continuous stream of power,

even when the ambulance is not running.

The County anticipates that these technologies will not only help to reduce the vehicle’s

carbon emissions, but also increase fuel economy, and reduce engine maintenance and fuel

costs. Other jurisdictions are monitoring Oxford County’s pilot with great anticipation.

APEXPRO was asked to review the County’s decision to trial a hybrid ambulance, in lieu of a

more conventional fuel‐efficient vehicle. For this purpose, we consulted with multiple Ontario

EMS services. The options that we examined, and our findings based on peer experience, are

discussed below.

Option 1: Use of a smaller van style ambulance (Type 2) in lieu of the County’s larger box

style (Type 3). We concluded that the smaller van, while potentially more fuel efficient, is

inconsistent with OCPS’ core business needs.

Option 2: Use of a Ford chassis in lieu of a Chevy chassis. Most Ontario EMS peers operate

with ambulances manufactured using either a Ford or a Chevy chassis. According to peers,

both chassis are similar in terms of reliability, and fuel‐consumption.

Option 3: Use of a relatively new entry to the Ontario market – specifically the Demers

Ambulance MX152, which is constructed on a Mercedes‐Benz Sprinter 3500 chassis, and is

equipped with an Ecosmart idle reduction system that provides technological advantages

similar to those described above for the XL3 hybrid’s AceTech Eco‐Run anti‐idling system.

The Demers Ambulance MX152 is used by Niagara Regional EMS. One or two are also being

trialled by Waterloo Region. In contrast to the XL3 hybrid (electric/gas) ambulance

selected by Oxford County, the Demers Ambulance MX152 operates on diesel fuel.

According to media reports, both vehicles ‐ the XL3 hybrid and the Demers Ambulance

MX152 ‐ are alleged to significantly increase fuel economy by up to 20%, and to reduce fuel

costs by a similar amount. Both Niagara and Waterloo affirm that fuel cost savings have

been observed using the Demers Ambulance MX152 – albeit, it is still too early to attest to



a definitive figure. As the XL3 hybrid is a new vehicle model, with only three months

operating experience, for that vehicle definitive operating statistics are not yet available.

Both vehicles are also alleged to reduce maintenance costs, but again Niagara and

Waterloo are of the position that it is still too early to quantify. And since the XL3 hybrid is

a new vehicle model, operating statistics for that vehicle are not yet available.

Both vehicles are also alleged to reduce time out of service. In this respect, views are

mixed, with some suggesting that managing a vehicle’s time out of service can be a major

challenge, particularly if a certified mechanic is not locally available and the vehicle has to

be transported to a distant garage for servicing. Niagara, which operates a fleet of over 40

MX152 ambulances, resolved this challenge by having a local mechanic certified by the

manufacturer to work on their vehicles.

In consideration of the above, it is our opinion that Oxford County should take the next 12

months or so, to assess the fuel‐economy, cost‐efficiency and reliability of the newly acquired

XL3 hybrids. In the absence of comparable operating statistics and costs, there is no

justification for the County to alter its current course.

Moreover, we understand that ambulance manufacturers are considering the possibility to

develop a fully‐electric powered ambulance, and we anticipate that more information on this

will be available in 12 months, for the County’s additional consideration.

4.3 EMS Staffing Pattern

In 2010, OCPS ambulances were staffed a total of 54,228 vehicle‐hours. In 2011, in response to

rising call volumes, ambulance staffing was increased to 60,173 vehicle‐hours a year. In 2013,

staffing was reduced to 58,087 vehicle‐hours, with the removal of a weekday car; this, in

anticipation of a diversion of non‐urgent, inter‐institutional transfers to a newly contracted

non‐ambulance transport provider. 11

The staffing level has remained fixed since 2013, at 58,087 vehicle‐hours a year. As shown by

Exhibit 4.1 (next page), the approved split in annual coverage is 32,537 vehicle‐hours during the

day (i.e., 07:00‐19:00 hours), and 25,550 vehicle‐hours at night (19:00‐07:00 hours).

Daytime coverage peaks at 8 staffed ambulances on weekdays, and drops to 7 on weekends

(i.e., Tillsonburg station staffs only 1 ambulance on weekends).

Night‐time coverage is 6 staffed ambulances, dropping to 5 between 02:00 and 06:00 hours,

(i.e., Drumbo station does not staff an ambulance during these 4 night‐time hours).

11 Discussed further in Section 4.10 of this report.



EXHIBIT 4.1: CURRENT AMBULANCE STAFFING PATTERN

4.4 Spare Ambulances

As discussed above, there are a total of 12 ambulances in the OCPS fleet, and the concurrent

staffing of ambulances peaks at 8 staffed ambulances. This means, that on record, the fleet

operates with 4 spare ambulances.

Recommendation: OCPS’ experience shows that as many as 2 ambulances are out of service,

for maintenance or repairs, at any given time. Therefore, in practice, the fleet operates with

only 2 spares. This practice is inconsistent with industry leading practices (i.e., it is too lean),

and we recommend that the service should acquire at least 1 additional fully‐equipped spare

ambulance – preferably in the near term.

DAY / NT STATION

# OF

STAFFED

AMB'S

SHIFT START & END

SHIFT

LENGTH

(HRS)

# OF DAYS

PER WEEK

ANNUAL

VEH‐HRS

DAY 00 ‐ MILL ST, WOODSTOCK 1 07:00 ‐ 19:00 12 7 4,380

DAY 01 ‐ BYSHAM, WOODSTOCK 1 07:00 ‐ 19:00 12 7 4,380

DAY 02 ‐ INGERSOLL 1 07:00 ‐ 19:00 12 7 4,380

DAY 03 ‐ TILLSONBURG 1 07:00 ‐ 19:00 12 7 4,380

03 ‐ TILLSONBURG (WKDYS) 1 07:00 ‐ 17:00 10 5 2,607

DAY 04 ‐ NORWICH 1 07:00 ‐ 19:00 12 7 4,380

DAY 05 ‐ DRUMBO 1 06:00 ‐ 16:00 10 7 3,650

DAY 07 ‐ ZORRA 1 07:00 ‐ 19:00 12 7 4,380

TOTAL ‐ DAYS 8 32,537

NT 00 ‐ MILL ST, WOODSTOCK 1 19:00 ‐ 07:00 12 7 4,380

NT 01 ‐ BYSHAM, WOODSTOCK 1 19:00 ‐ 07:00 12 7 4,380

NT 02 ‐ INGERSOLL 1 19:00 ‐ 07:00 12 7 4,380

NT 03 ‐ TILLSONBURG 1 19:00 ‐ 07:00 12 7 4,380

NT 04 ‐ NORWICH 1 19:00 ‐ 07:00 12 7 4,380

NT 05 ‐ DRUMBO 1 16:00 ‐ 02:00 10 7 3,650

TOTAL ‐ NIGHTS 6 25,550

TOTAL ‐ DAYS & NIGHTS 58,087

The total number of staffed ambulances drops to 7 vehicles on weekends.

The total number of staffed ambulances drops to 5 vehicles from 02:00‐06:00.



4.5 EMS Deployment & Utilization Plan

As previously discussed in this report, in the province of Ontario, provision of land ambulance

services is a shared provincial‐municipal responsibility. UTM/DDA are responsible to provide

reasonable levels of ambulance resourcing within their designated areas; whereas, MOHLTC, by

way of a province‐wide network of CACCs, is responsible to properly dispatch the UTM/DDA

land ambulance resources.

More specifically, Oxford County is responsible to provide reasonable levels of ambulance

resourcing for the County and its eight constituent communities, whereas the MOHLTC‐

operated CACC based in London Ontario is responsible to properly dispatch the County’s land

ambulance resources.

To ensure the effectiveness and efficacy of their relationship, OCPS and the London CACC have

agreed on a “Deployment & Utilization Plan”, that contains guidelines and other relevant

information, to ensure that the County’s land ambulance resources are dispatched in a manner

that respects the County’s interests.

The Plan’s contents include: a minimum emergency coverage policy, standby policy, tiered

response protocols, non‐urgent transfer guidelines, and guidelines for keeping OCPS

management informed of any major issues.

APEXPRO has reviewed the Deployment & Utilization Plan and in our opinion, it serves the

intended objectives, as paraphrased below drawing from the contents of the document.

To ensure optimum land ambulance coverage and response times to medical emergencies

within Oxford County.

To accommodate non‐urgent calls/transfers, so long as Oxford County’s land ambulance

service emergency response capability is not compromised.

To assist with medical emergencies in neighbouring municipalities, so long as coverage and

response times to medical emergencies in the County are not compromised.

While the Deployment & Utilization Plan is intended primarily to guide the activities of the

London CACC’s Ambulance Communications Officers (ACO), it also serves as a guide for OCPS

paramedics, Platoon Superintendents, and other land ambulance services personnel. The Plan

is a living document that is occasionally refined as appropriate.

4.6 Standby Emergency Coverage

Sixty percent (60%) of Oxford County’s EMS call volume is generated by the City of Woodstock,

and the Towns of Tillsonburg and Ingersoll.

By policy, OCPS endeavours to maintain a minimum of 1 readily available ambulance in each of

these urban centres at all times.

What this means is that when an ambulance stationed in one of these urban centres is

dispatched to a call, then CACC will deploy a rural‐based ambulance to perform standby

emergency coverage for that urban community. More specifically, an ambulance based at



Zorra, Drumbo or Norwich, is required to temporarily abandon its rural base and relocate to a

predetermined position closer to/within the urban community to provide that area with

emergency coverage.

As stated by Oxford County Emergency Coverage Policy …. when reinstating emergency

coverage for Woodstock, Ingersoll and Tillsonburg, the closest available ambulance will be

utilized and if necessary, a second stand‐by will be initiated.

Generally, Zorra when available, provides standby coverage for Ingersoll or Woodstock as a

first choice.

When Zorra is not available then Drumbo provides standby coverage for Woodstock as a

first choice.

Norwich when available, provides standby coverage for Tillsonburg as a first choice.

In prior years, when urban centre call volumes were lower, this coverage policy worked well, as

rural ambulances were called upon infrequently to provide standby coverage.

Today, the policy does not work as was originally intended. Rapidly rising EMS demand in the

urban centres is exacerbating land ambulance deployment, and rural ambulances are

frequently called on to perform standby emergency coverage or to attend calls in urban centres

of the County.

As further discussed in Section 7.6 of this report, rural ambulances spend only 10% of their

time in their coverage zones, and almost 85% of their time performing standby or attending

calls in the urban centres.

This and other findings that will be discussed in subsequent sections of this report, lead us to

conclude that the urban centre(s) of the County require additional land ambulance resourcing

in the near‐term.

4.7 EMS Shift Overrun

EMS shift overrun is primarily attributed to the following:

Priority 3 or 4 call occurring close to end of shift, and the crew is staffing the nearest

available ambulance.

Priority 8 standby occurring close to end of shift, and the crew is staffing the nearest

available ambulance.

Crew’s return to base being delayed while completing an out‐of‐County Priority 4 transfer.

Paramedics requiring additional time to complete paperwork, or restock an ambulance.

OCPS incurs about 2,500 to 2,600 shift overruns a year; with each occurrence averaging

roughly 0.76 hours.

In 2016, shift overrun totalled almost 2,000 person‐hours for which, paramedics were paid

time and one‐half. This figure represents a 1.7% increase in the planned (and approved)

staffing pattern for the year.



On a percentage basis, shift overrun did not vary significantly by ambulance station, with all

but two reporting similar values. The two exceptions are Norwich and Zorra. In 2016, these

two stations reported slightly higher increases in approved staffing levels due to shift overrun,

of 2% and 2.9% respectively.

4.8 Ambulance Offload

Ambulance offload time refers to the time that paramedics spend in a hospital Emergency

Department (ED) awaiting transfer of patient care to hospital personnel. Offload delay is

defined as ambulance offload time greater than 30 minutes (which historically has been the

norm).

Presented below are ambulance offload times for the months of April, May and June 2017, for

hospitals situated in Oxford County and in adjacent municipalities. The information is

extracted from a provincially published report entitled “ER Ambulance Offload Time Report”.

The report is published monthly.

EXHIBIT 4.2: AMBULANCE OFFLOAD TIMES

For hospitals situated in Oxford County ‐ Woodstock General Hospital, Tillsonburg District

Memorial Hospital, and the Alexandra Hospital in Ingersoll ‐ most offload times are 30 minutes

or less, i.e., ambulance offload is not an issue.

In contrast, for hospitals in adjacent municipalities ‐ London Health Sciences Centre, Cambridge

Memorial and Grand River Hospital ‐ offload times typically exceed 1 hour, and offload delays

are extensive.

OCPS stakeholders support these findings, stating that transfers by ambulance to out‐of‐county

hospitals encounter frequent offload delays of an hour or more. Also, following completion of a

transfer, CACC will frequently assign the Oxford County ambulance to a subsequent out‐of‐

County call before it is permitted to return to base.

APRIL 2017 MAY 2017 JUNE 2017 APRIL 2017 MAY 2017 JUNE 2017

(minutes) (minutes) (minutes) (minutes) (minutes) (minutes)

WOODSTOCK GENERAL HOSPITAL 20 21 23 ‐‐ ‐‐ ‐‐

TILLSONBURG DISTRICT MEMORIAL

HOSPITAL38 33 32 8 3 2

ALEXANDRIA HOSPITAL, INGERSOLL 31 38 25 1 8 ‐‐

LONDON HEALTH SCIENCES CENTRE ‐

UNIVERSITY HOSPITAL84 102 92 54 72 62

LONDON HEALTH SCIENCES CENTRE ‐

VICTORIA HOSPITAL86 107 84 56 77 54

CAMBRIDGE MEMORIAL HOSPITAL 58 71 83 28 41 53

GRAND RIVER HOSPITAL ‐ KITCHENER‐

WATERLOO69 69 78 39 39 48

AMB. OFFLOAD (90TH PERCENTILE) OFFLOAD DELAY (90TH PERCENTILE)



4.9 Medical Tiered Response

Medical Tiered Response is the term used to describe a ‘non‐ambulance’ emergency

responder’s support of a paramedic service. A medical tiered response agreement is an

agreement that sets out the terms and criteria by which a non‐ambulance emergency

responder will be deployed to the scene of a medical emergency.

Such agreements typically provide for the following non‐ambulance emergency responder

support:

Immediate response to medical emergencies, life‐threatening calls, and calls where they

may be of assistance to the paramedic service in the provision of patient care, e.g.: calls

involving cardiac/respiratory arrest, unconsciousness, choking, industrial accidents,

agricultural accidents, construction accidents, and motor vehicle collisions.

Immediate response to other selected medical calls that the CACC categorizes as Priority 4,

if an ambulance is not readily available and the non‐ambulance emergency responder can

respond more quickly than paramedics, e.g.: calls involving an allergy reaction,

electrocution, diabetic problem, and trauma.

Non‐ambulance emergency responders include allied emergency services (e.g., fire or police)

and organized groups of volunteers, whose members are trained to a basic level of first aid.

As shown in Appendix C, non‐ambulance emergency responders typically receive 8 to 40 hours

of in‐service training in basic first aid, CPR and in the use of an automated external defibrillator

(AED). In comparison, the minimum requirements for paramedic licensure include a 2‐year

college program of paramedical training, annual recertification by a Base Hospital, and

continuous performance oversight to ensure patient care services to provincial standards.

Medical treatments that a non‐ambulance emergency responder may provide, include the

provision of basic first aid treatment, CPR, automated defibrillation, dispensation of suction,

oxygen, and basic airway management.

Non‐ambulance emergency responders do not have authority for patient transport. They will

respond to the medical emergency, provide the patient with medical assistance to the extent

permitted by their training, and await arrival of an ambulance.

Non‐ambulance emergency responders are particularly effective in serving rural communities,

where infrequent medical calls, and the high cost to operate an ambulance, preclude the

establishment of local EMS coverage.

Oxford County has entered into medical tiered response agreements with the following area

(constituent) municipalities:

City of Woodstock, on behalf of their Police and Fire Services

Blandford‐Blenheim, East Zorra‐Tavistock, Ingersoll, Norwich, South West Oxford, and

Zorra, on behalf of their volunteer Fire departments.

The agreements were entered voluntarily by the area municipalities, and the municipalities

assume responsibility for all costs associated with the support that their non‐ambulance



emergency responders provide; albeit, Oxford County’s paramedic services program maintains

a small budget allocation for the replacement of specific medical supplies.

Most of the medical tiered response agreements between the County and the area

municipalities have been in place for over a decade, and the parties are working progressively

to have them updated.

For example, the agreement between the County and the City Woodstock on behalf of the

City’s fire department was updated in 2014; the City’s agreement on behalf of the police

department was updated in 2015; and the Blandford‐Blenheim Township agreement on behalf

of their volunteer fire service was recently updated, in December 2017.

Currently, there is no medical tiered response agreement between the County and the Town of

Tillsonburg. The Establishing and Regulating By‐Law for the Town’s volunteer Fire Department

does not authorize tiered medical support as a core service. Regardless, Tillsonburg firefighters

will provide medical support if already on scene to provide fire suppression or emergency

rescue services. Discussions ongoing, may change the situation over time, and result in a

medical tiered response agreement between the County and the Town of Tillsonburg.

4.10 Non‐Ambulance Patient Transfer Services

An inter‐institutional patient transfer is intended to mean transport of a patient (either an

inpatient or an outpatient) by vehicle between two hospitals, or between a hospital and a

nursing home, or like facility. It is not intended to mean the portering of a patient between

two departments internal to an institution.

Historically, Ontario hospitals have relied extensively on ambulance services for inter‐

institutional transport of both emergency and non‐emergent (non‐urgent) patients.

To manage the rapidly growing demand for ambulance services, many municipalities /

designated delivery agents have adjusted their land ambulance Deployment Plans, introducing

policies that permit the continued use of ambulances for non‐urgent inter‐institutional patient

transport, so long as the ambulance service’s emergency response capability is not

compromised.

Oxford County’s land ambulance Deployment & Utilization Plan includes such a policy

statement.

Such polices are consistent with the Ambulance Act, which states that … an ambulance is

intended for the transportation of persons

who have suffered a trauma which could endanger their life, limb or function; or

have been judged to be in an unstable medical condition and to require, while being

transported, the care of a health care provider and the use of a stretcher.

By necessity, many hospitals have contracted with alternative (non‐ambulance) providers of

patient transportation services for the routine transport of non‐urgent, medically stable

patients, i.e., for patients who do not meet the provincial criteria for transport by ambulance.



To be clear, the reference herein, is to a patient who has been judged by a hospital physician or

their designate, to be medically stable and where there is relatively little risk that their medical

condition will deteriorate during travel. Patients who meet the provincial criteria for transport

by ambulance, will continue to be transported by ambulance.

In 2013 the South‐West LHIN hospitals, including the three hospitals situated in Oxford County

(Woodstock General Hospital, Tillsonburg District Memorial Hospital, and the Alexandra

Hospital in Ingersoll), contracted Voyageur Transportation (a non‐ambulance patient

transportation service) for non‐urgent inter‐facility patient transfers.

Voyageur’s scope of services includes stretcher van, wheelchair van, and conventional

auto/taxi for those who can travel by conventional sedan – albeit, all decisions concerning a

patient’s transportation are made by a hospital physician, or their designate, based on the

patient’s medical condition, care and comfort requirements.

According to transfer records provided by Voyageur, in each of 2015 and 2016 their vehicles

completed a combined total of over 2,000 non‐urgent patient transfers for the three hospitals

situated in Oxford County. This includes non‐urgent patient transfers completed within the

County, as well as those to/from hospitals situated in neighbouring upper tier municipalities,

i.e., to/from London Health Sciences Centre, Cambridge Memorial Hospital, etc.

The average inter‐facility patient transfer duration was about 1 hour. 12 This means that

Voyageur’s services successfully helped to reduce OCPS’ workload by about 2,000 vehicle‐hours

in each of 2015 and 2016. Assuming a Unit Hour Utilization of 35%, this volume of work

equates to a reduction in ambulance staffing of about 1.8 ambulances operating 12 hours each

weekday. 13

12 This figure is a weighted average based on transfers of short duration completed within the County and transfers of relatively long duration to/from out-of-County hospitals which, oftentimes can be of 2 to 3 hours, or more. 13 Unit Hour Utilization is discussed in Section 9 of this report.



5 PARAMEDIC SERVICE COSTS

5.1 Paramedic Service Costs, 2014‐2017

Oxford County’s expenditures on paramedic services, 2014‐2017, are shown in Exhibit 5.1.

In 2014 the gross expenditure on paramedic services was $10.58 million. The budgeted 2017

expenditure is $11.34 million. This works out to an increase in annual spending of about 2.3%

per annum over the four years. 14

In each of the years, 2014‐2016, the province provided the County with an operating grant

roughly equal to 48% of the annual ambulance service expenditure; also, the County generated

revenue of about 2% from other sources. As a result, the municipal share of expenditures has

been held at approximately 50% of gross.

EXHIBIT 5.1: PARAMEDIC SERVICE COSTS

Salaries and benefits account for approximately 77% of the total annual expenditure. Other

expenses (i.e., vehicle operating costs, equipment repairs, medical supplies, oxygen, utilities,

insurance, etc.) account for 23% of total. These figures are consistent with those reported by

other Ontario EMS services.

14 In comparison, the demand for ambulance services has been increasing at an average rate of 5% per annum.

$ % $ % $ % $ %

SALARIES & BENEFITS

SALARIES $6,755,688 64% $6,683,774 63% $6,780,385 62% $6,966,260 61%

BENEFITS $1,519,406 14% $1,473,926 14% $1,575,522 14% $1,739,201 15%

$8,275,094 78% $8,157,700 77% $8,355,907 77% $8,705,461 77%

OTHER EXPENSES

PROGRAMMING $1,854,617 18% $2,060,744 20% $1,578,473 15% $2,080,761 18%

VEH'S & EQUIP'T CAPITAL $452,348 4% $343,976 3% $937,800 9% $557,650 5%

$2,306,966 22% $2,404,720 23% $2,516,273 23% $2,638,411 23%

GROSS EXPENSES $10,582,060 100% $10,562,420 100% $10,872,180 100% $11,343,872 100%

REVENUE

PROVINCIAL GOV'T ($5,055,373) ‐ ($5,137,304) ‐ ($5,183,517) ‐ ($5,486,389) ‐

OTHER SOURCES ($121,070) ‐ ($188,620) ‐ ($213,219) ‐ ($171,000) ‐

TOTAL REVENUE ($5,176,443) ‐ ($5,325,924) ‐ ($5,396,736) ‐ ($5,657,389) ‐

MUN'L SHARE OF EXPENSES $5,405,617 51% $5,236,496 50% $5,475,444 50% $5,686,483 50%

2014 ACTUAL 2015 ACTUAL 2016 ACTUAL 2017 BUDGET



5.2 All‐Inclusive Cost to Fully Staff an OCPS Ambulance

The all‐inclusive cost to fully staff an ambulance is a useful KPI, particularly for benchmarking to

peer EMS services.

Our estimates of the all‐inclusive cost to fully staff an OCPS ambulance are shown in Exhibit 5.2.

We derived these estimates by dividing the annual cost of the service by the annual number of

staffed ambulance‐hours.

We estimate that in 2016, the all‐inclusive cost to fully staff an OCPS ambulance was about

$187 an hour, or $819,800 a year for a 12‐hour shift. The budgeted 2017 costs are estimated

to be $195 an hour, or $855,400 a year for a 12‐hour shift.

EXHIBIT 5.2: COST TO FULLY STAFF AN OCPS AMBULANCE

Costs prior to any provincial subsidy

5.3 Incremental Cost to Staff an Additional Ambulance‐Hour

To ascertain what it will cost to staff an ambulance for an additional few hours, or for an

additional shift, it would be inappropriate to base that cost on the all‐inclusive figures provided

above, as they not only account for the direct cost to operate a vehicle, but they also account

for ancillary costs, including management, supervisory oversight, administrative support, minor

capital, debt repayment and reserve contributions.

For such purposes, using an incremental cost based only on the direct cost to operate a vehicle,

would be more appropriate. This is the approach that we have adopted, as described below.

OCPS’ all‐inclusive budgeted expenditure for 2017 is $11,343,872. Deleting the above

ancillaries, the net cost for 2017 is estimated at $9,146,986. Dividing the net cost by the annual

number of staffed ambulance‐hours, we arrive at the following incremental cost estimates for

OCPS. Again, these cost estimates are prior to any provincial subsidy:

Incremental hourly cost $157

Incremental annual cost to operate 12/7 $690,000

Incremental annual cost to operate 24/7 $1,380,000

2014 2015 2016 2017

ACTUAL ACTUAL ACTUAL BUDGET

GROSS EXPENDITURE $10,582,060 $10,562,420 $10,872,180 $11,343,872

ANNUAL VEHICLE‐HOURS 58,087 58,087 58,087 58,087

EST'D HOURLY COST $182 $182 $187 $195

EST'D ANNUAL COST (12/7) $797,900 $796,500 $819,800 $855,400

EST'D ANNUAL COST (24/7) $1,595,800 $1,593,000 $1,639,600 $1,710,800



6 PEER COMPARISONS

6.1 Comparative Spending on EMS

APEXPRO compared the County’s

paramedic services costs to those of 17

peer EMS services in Ontario.

The peers ranged in population from

59,297 to 161,531 residents.

For peers, the data is derived primarily

from year end Financial Information

Return (FIR) reports that are posted on

the Ministry of Municipal Affairs website.

Costs are compared for the budget year

2016. The figures shown are the all‐

inclusive costs prior to the application of

any provincial subsidy.

For 2016, the all‐inclusive cost to fully

staff an OCPS ambulance was $187 per

vehicle‐hour.

The median value among the surveyed peers was $195 per vehicle‐hour, as shown by Exhibit

6.1. On this basis, we conclude that Oxford County’s cost to staff an ambulance is similar to

that of peers.

EXHIBIT 6.1: PEER COMPARISON OF HOURLY COSTS

$0

$50

$100

$150

$200

$250

$300

Gross Expenditures Prior to Provincial Subsidy

HOURLY COST TO STAFF AN AMBULANCE (2016)

OXFORD ‐ $187MEDIAN ‐ $195

CENSUS 2016 SQ. KM. POP'N DENSITY

HURON 59,297 3,399 17

DUFFERIN 61,735 1,486 42

NORFOLK 64,044 1,608 40

KAWARTHA LAKES 75,423 3,084 24

PERTH 76,796 2,219 35

ELGIN 88,978 1,881 47

GREY 93,830 4,514 21

LEEDS & GRENVILLE 100,546 3,383 30

CHATHAM‐KENT 101,647 2,456 41

RENFREW 102,394 7,449 14

OXFORD 110,862 2,040 54

CORNWALL 113,429 3,310 34

LAMBTON 126,638 3,002 42

BRANT 134,808 1,093 123

HASTINGS 136,445 6,104 22

PETERBOROUGH 138,236 3,848 36

FRONTENAC 150,475 3,788 40

GREATER SUDBURY 161,531 3,228 50



In 2016, Oxford County’s annual spending on EMS was about $95 per resident. For peers, the

annual spending was on average 25% higher, with most ranging between $103 and $159 per

resident, as shown in Exhibit 6.2. 15

EXHIBIT 6.2: PEER COMPARISON OF EMS SPENDING PER RESIDENT

In 2016, Oxford County’s annual spending on EMS was about $825 per ambulance response.

The median spending among peers was 18% higher at $970 per annum, as shown in Exhibit 6.3.

EXHIBIT 6.3: PEER COMPARISON OF EMS SPENDING PER AMBULANCE RESPONSE

We attribute the higher spending by peers – per resident and per ambulance response – to

their provision of higher levels of coverage, i.e., their deployment of larger numbers of staffed

ambulances, as discussed further in the next section of this report.

15 Annual spending per resident is calculated by dividing the annual reported FIR spending, by the Census 2016 population. The Census population is based on permanent residents, i.e. it excludes temporary/seasonal residents.

$0

$500

$1,000

$1,500

$2,000

Gross Expenditures Prior to Provincial Subsidy. Figures are Based on Pr 1‐4 Calls

EMS SPENDING PER AMBULANCE RESPONSE (2016)


$0

$50

$100

$150

$200

$250

Gross Expenditures Prior to Provincial Subsidy

EMS SPENDING PER RESIDENT (2016)




6.2 Comparative Resourcing

Exhibit 6.4 presents a comparison of OCPS’ resourcing relative to peer EMS services of

comparable, and slightly larger size. Our observations are as below.

OCPS’ organizational structure is consistent to that of peers. Each service employs a Chief, 2

deputies, 4 or more supervisors, a paramedic complement, and several support personnel.

The Cornwall paramedic service, with comparable population and call volume, is a good

comparator to OCPS, as are the EMS services operating in Grey and Lambton Counties.

Relative to these peers, OCPS’ front‐line resourcing is lean:

The number of paramedics employed by these services is higher (Cornwall by 30%).

Their staffed vehicle‐hours are higher (Cornwall by 40%).

The number of ambulances deployed during peak hours is higher (all by 25%).

As further shown by Exhibit 6.4, many peers (Cornwall, Lambton, Peterborough and Frontenac)

also resource the training and logistics support functions with larger numbers of staff.

Oxford and Brant are the only two counties that require their supervisors to staff ambulances ‐

unlike other peers that require supervisors to perform first response when an ambulance is

delayed. The Brant Paramedic Service is awaiting a decision on a request to make this change

in 2018; also, to recruit an additional (a 5th) supervisor. If these requests are approved, then

Brant County’s paramedic complement will increase by 4 additional personnel (beyond that

shown in the exhibit).

EXHIBIT 6.4: COMPARATIVE RESOURCING AMONG PEERS

Brant County Paramedic Service has received approval to add an additional 12 vehicle‐hours of coverage per day in

2018. For this purpose, they are recruiting 4 additional full‐time paramedics. These figures are included above.

OXFORD GREY CORNWALL LAMBTON BRANT PETERBOROUGH FRONTENAC

POPULATION (CENSUS 2016) 110,862 93,830 113,429 126,638 134,808 138,236 150,475

CHIEF OF EMS 1 1 1 1 1 1 1

DEPUTY CHIEF 2 2 2 1 2 2 2

PARAMEDIC SUPERINTENDENTS 4 4 4 5 4 4 6

PARAMEDICS (FT & PT) 88 121 115 150 93 123 148

TRAINING & QUALITY ASSURANCE 1 ‐‐ 2 1 ‐‐ 2 1

LOGISTICS & SCHEDULING (FT & PT) 1 ‐‐ 3 2 ‐‐ 2 3

ADMINISTRATIVE/CLERICAL (FT & PT) 1 2 1 1 1 3 2

AMBULANCE BASES 7 7 7 9 4 6 8

AMBULANCES (TOTAL) 12 15 14 15 11 14 16

AMBULANCES (PEAK STAFFING) 8 10 10 10 8 9 11

SPARE AMBULANCES 4 5 4 5 3 5 5

SPARES AMB'S AS A % OF TOTAL 33% 33% 29% 33% 27% 36% 31%

STAFFED VEHICLE‐HOURS 58,087 72,418 83,220 87,600 56,940 72,276 75,920

PARAMEDIC SUPERV'S PER SHIFT L.T. 1 1 1 1 L.T. 1 1 1 ‐ 2

AMBULANCE RESPONSES (PR 1‐4) 12,850 9,700 13,200 14,600 16,650 21,600 20,200



7 OCPS RESPONSE TRENDS

The following statistics are derived from the Ambulance Dispatch Reporting System (ADRS)

database managed by MOHLTC, which contains pertinent details of each call for EMS

assistance, and each dispatched ambulance response.

ADRS data is typically 6 months in arrears. Hence, our analysis within this report is based on

data for 2016 and prior years, specifically 2011‐2016. We are confident in the reasonableness

of the statistics, as we inspected the database for comprehensiveness and accuracy.

Unless otherwise stated, the tabulations within this report represent ‘ambulance responses’

performed by OCPS. Ambulance response volumes are higher than the volume of requests for

medical assistance that CACC receives (up to 10% higher).

Reasons for this, include: (a) Call may be cancelled while a deployed ambulance is on route; (b)

Some requests require CACC to deploy multiple ambulances, e.g., multi‐vehicle collisions and

multi‐casualty incidents; and (c) occasionally, a deployed ambulance may be redirected to a

higher priority call, requiring CACC to deploy an alternate ambulance.

7.1 Response Trends, 2011‐2016

Demand for land ambulance services is increasing relatively rapidly in Oxford County and in

many other Canadian jurisdictions. The rapid increase in EMS demand is attributed primarily to

a relatively rapid growth in seniors’ population, which in multiple municipalities is reported to

be at least 3‐5 times faster than that of the general population.

Exhibit 7.1 presents the response trends for OCPS’ ambulances, for the period 2011 to 2016.

EXHIBIT 7.1: AMBULANCE RESPONSE TRENDS, 2011‐2016

In 2016, OCPS performed 22,650 ambulance responses. Fifty‐five percent (55%) were

dispatched as high priority (Priority 3 and 4), to urgent and potentially life‐threatening medical

2011 2012 2013 2014 2015 2016

TOTAL 18,229 19,019 18,692 18,993 19,803 22,650

PR 8 STANDBY 7,114 7,130 7,277 8,196 8,740 9,817

PR 3 & 4 8,899 9,564 9,807 10,405 10,759 12,407

PR 1 & 2 2,216 2,325 1,608 392 304 426

0

5,000

10,000

15,000

20,000

25,000

AMBULA

NCE RESPONSES

OCPS AMBULANCE RESPONSE TRENDS



emergencies; and 43% were dispatched as a standby posting (Priority 8). Voyageur

Transportation has successfully helped to reduce OCPS’ workload by over 2,000 non‐urgent

patient transfers a year. Because of this, OCPS responds to relatively few calls that are

dispatched as non‐urgent (Priority 1 and 2), i.e., about 400 or fewer, a year.

High priority ambulance response volumes are increasing at a rapid rate exceeding 5.3% per

annum. Standby postings are also increasing rapidly. This notwithstanding, because OCPS

responds to relatively few non‐urgent calls, the service has been able to manage the total

demand for the past few years.

This is no longer the case. The rapidly rising ambulance response volumes are adversely

impacting ambulance response time and workload, particularly the workload of rural‐based

ambulances. Both response time and workload are discussed further, in subsequent sections of

this report.

7.2 Response Time Trends, 2011‐2016

Exhibit 7.2 presents both the annual response volume and response time for OCPS’

ambulances, for the period 2011 to 2016.

EXHIBIT 7.2: OCPS RESPONSE TIME TRENDS

Response times shown in this exhibit, are for calls of highest priority, i.e., calls dispatched as

Priority 4. They are for the interval T2‐T4, where T2 is the time that an ambulance crew is

notified of the call, and T4 is the time of their arrival on scene.

In 2014, the 90th percentile response time County‐wide was 10:39, i.e., 90 percent of all Priority

4 calls (potentially life‐threatening medical emergencies) were responded to in 10 minutes and

39 seconds, or less. In 2016, because of rapidly increasing EMS demand, the 90th percentile

response time County‐wide was 8% longer, at 11:31.

18,22919,019

18,692 18,993 19,803

22,650

0

3,500

7,000

10,500

14,000

17,500

21,000

24,500

2015 2016

OCPS RESPONSE TIME TRENDS

11:08 11:00 10:5610:39

11:38 11:31

2011 2012 2013 201409:00

10:00

11:00

12:00

13:00

14:00

15:00

16:00

AMBULA

NCE

RES

PONSES

90TH % RESP. TIME TO PR 4 CALLS (T2‐T4)AMB. RESPONSES (PR 1‐4 & 8)

MINUTE

S : SEC

ONDS



7.3 Code Critical Trends, 2016‐2017

Exhibit 7.3 presents the Code Critical trend for OCPS’ ambulances, from September 2016 to July

2017, i.e., instances when there were 3 or fewer ambulances available to take the next call.

Code Critical occurrences averaged 71 a month, and the monthly elapsed time on Code Critical

averaged 135 hours. The average duration of a Code Critical incident was 1.9 hours, with

almost 15% of Code Critical occurrences lasting 4 hours or more.

EXHIBIT 7.3: CODE CRITICAL, 2016‐2017

7.4 Response Dispersion by Call Origin, 2016

In calendar year 2016, the Oxford County

Paramedic Service performed 8,229 responses

to medical incidents of highest dispatch priority

(Priority 4).

Exhibit 7.4 shows the location of these incidents

plotted onto a service area map, and Exhibit 7.5

(next page) presents a breakdown by area

municipality, as well as the 90th percentile

response times.

As shown by Exhibit 7.5, the City of Woodstock,

which is the largest population centre in the

County, generates the highest EMS call volume;

about twice that of Tillsonburg and almost 4

times that of Ingersoll.

In total 60% of all Priority 4 calls are generated

in the three urban centres (Woodstock,

Ingersoll and Tillsonburg), at 90th percentile

SEP '16 OCT NOV DEC '16 JAN '17 FEB MAR APR MAY JUN JUL

Incidents 55 69 81 97 60 60 58 65 69 85 83

Hours 84 145 124 149 119 113 134 164 147 177 127

0

20

40

60

80

100

120

140

160

180

200

CODE CRITICAL (3 OR FEWER AMBULANCES AVAILABLE)

EXHIBIT 7.4: RESPONSE DISPERSION BY CALL ORIGIN



response times ranging between 07:47 and 08:24. Twenty‐nine percent (29%) are generated in

the rural townships, with 90th percentile response times ranging between 11:57 and 19:57.

County‐wide, in 2016, 90% of all Priority 4 calls were responded to in 11:31 or less.

Southwest Oxford’s 90th percentile

response time is particularly interesting.

While there is no locally based

ambulance station in Southwest Oxford,

its 90th percentile response time, at

11:57, is substantially lower than that of

any other rural township of the County.

We attribute this to the excellent

coverage provided by ambulances

stationed adjacent to Southwest Oxford’s

northern and southern boundaries, in

Ingersoll and Tillsonburg.

The data shown in the above two exhibits

was extracted from the ADRS database.

ADRS does not include information on persons who, in lieu of calling/awaiting an ambulance

response, are transported to hospital by family or other means. We are advised that in rural

townships, the potential demand for ambulance service may be higher than the statistics

shown.

The above exhibits also exclude calls in Oxford County to which neighbouring EMS services

responded. In 2016, neighbouring EMS services responded to 351 Priority 4 calls that originated

in Oxford County, two‐thirds of which took place in Blandford‐Blenheim and Norwich

Townships, i.e., area municipalities traversed by Highways 401 and 403.

7.5 Inter‐Institutional Transfers by OCPS Ambulances, 2016

Exhibit 7.6 (next page) shows the volume of patient transfers carried out by OCPS ambulances

in 2016. The exhibit includes inter‐institutional patient transfers completed within the County,

as well as transfers to/from hospitals situated in neighbouring upper tier municipalities.

Thirty percent (30%) of all ambulance transfers are between institutions situated in Oxford

County; 46% are to/from institutions in London; 11% to/from institutions in Waterloo; and 13%

to/from other out‐of‐County institutions.

Eighty percent (80%) of all ambulance transfers are dispatched as high priority (Pr 3 & 4); 20%

are dispatched as low priority (Pr 1 & 2). This is, as would be expected since Voyageur

Transportation has successfully reduced OCPS’ workload by about 2,000 non‐urgent patient

transfers annually.

EXHIBIT 7.5: PRIORITY 4 CALLS BY AREA MUNICIPALITY (2016)

# %

WOODSTOCK 2,814 34% 07:50

INGERSOLL 771 9% 08:24

TILLSONBURG 1,417 17% 07:47

BLANDFORD‐BLENHEIM 448 6% 19:57

EAST ZORRA‐TAVISTOCK 322 4% 15:42

ZORRA 281 3% 14:32

NORWICH 559 7% 17:27

SOUTHWEST OXFORD 698 9% 11:57

OUTSIDE THE COUNTY 919 11% ‐‐

TOTAL 8,229 100% 11:31

PR 4 90% RESP.

TIMEMUNICIPALITY



EXHIBIT 7.6: INTER‐INSTITUTIONAL TRANSFERS BY OCPS AMBULANCES (2016)

7.6 Responses by Station, 2016

Exhibit 7.7 shows ambulance responses for 2016 by responding station. Ambulances based at

the four urban stations (Mill, Bysham, Ingersoll and Tillsonburg) performed almost 12,000

responses, of which: 9,600 (80%) were Priority 1‐4 calls involving patient contact; and 2,400

(20%) were Priority 8 standby.

Ambulances based at the three rural stations (Norwich, Drumbo and Embro) performed 10,650

responses, of which only 2,650 (25%) were Priority 1‐4 calls, and even fewer, only 1,200 (10%)

were Priority 1‐4 calls in their own coverage zones. Rural‐based ambulances also performed

about 500 out‐of‐County responses, and 7,500 Priority 8 standby – that’s almost 4 times the

number of standby carried out by ambulances stationed at urban bases.

In summary, rural‐based ambulances spend only 10% of their time in their coverage zones, 5%

out‐of‐County, and almost 85% of their time performing standby or attending calls in the urban

centres.

EXHIBIT 7.7: AMBULANCE RESPONSES BY STATION (2016)

00 MILL 01 BYSHAM 02 INGERSOLL03

TILLSONBURG04 NORWICH 05 DRUMBO 07 EMBRO

TOTAL 2,884 3,008 2,546 3,560 4,304 3,814 2,534

OUT‐OF‐COUNTY 72 107 101 328 115 350 81

PR 8 STANDBY 275 777 647 673 3,114 2,492 1,839

PR 1‐4 IN RURAL TWPS 676 537 491 434 476 486 249

PR 1‐4 IN URBAN CENTRES 1,861 1,587 1,307 2,125 599 486 365

0

1,000

2,000

3,000

4,000

5,000

AMBULA

NCE RESPONSES

OCPS RESPONSES BY STATION (2016)

Pr 1 Pr 2 Pr 3 Pr 4 Total

Within Oxford 155 40 302 56 553

To/From London 16 37 460 343 856

To/From Waterloo 3 105 21 85 214

Other Out‐of‐County 37 30 126 45 238

0

200

400

600

800

1000

PATIEN

T TR

ANSFER

S

INTER‐INSTITUTIONAL TRANSFERS BY OCPS AMBULANCES, 2016



7.7 Monthly, Daily & Hourly Response Profiles, 2016

Exhibit 7.8 presents the monthly ambulance response profile for calendar year 2016. The

month‐to‐month variations are relatively small, varying on average by about +/‐ 1%. This

finding is consistent with both the service’s historical profile, and statistics reported by other

land ambulance services.

EXHIBIT 7.8: MONTHLY RESPONSE PROFILE (2016)

Exhibit 7.9 presents the daily variation in ambulance responses for 2016. Weekdays (Mon‐Fri)

account for 73% of ambulance response activity; weekends (Sat‐Sun) account for 27%. These

statistics also are consistent with those reported by other land ambulance services.

EXHIBIT 7.9: DAILY RESPONSE PROFILE (2016)

Exhibit 7.10 (next page) presents the hourly response profile for calendar year 2016. Day shifts

(07:00‐19:00 hours) account for almost 63% of all ambulance response activity; night time

shifts (19:00‐07:00 hours) account for about 37%. Most ambulance responses dispatched as

Priority 1 & 2, take place on day shifts (07:00‐19:00 hours).



EXHIBIT 7.10: HOURLY RESPONSE PROFILE FOR OCPS (2016)

7.8 Time‐on‐Task, 2016

Time‐on‐task (i.e., call duration) is defined as the amount of time that an ambulance spends

attending to a call. Time‐on‐task is influenced by multiple factors, including: travel time to

scene, time at scene, patient transport time to a receiving facility, and offload time (i.e., time at

the receiving facility until the paramedic is relieved of their responsibility for the patient).

In keeping with industry best practices, time‐on‐task, is measured from the time that the

ambulance crew is notified (T2 unit dispatched) to the time that the ambulance completes the

call (either T7 call cleared, or T13 unit cancelled).

Time‐on‐task does not include time for discretionary activities that can otherwise be deferred if

the ambulance is needed to respond to a medical emergency, i.e., to complete documentation,

restock or clean an ambulance, etc.

Call completion occurs mainly at hospital, nursing home or other like facility, following patient

transport. Occasionally it may take place at scene if the patient declines ambulance transport.

Using the ADRS data we investigated OCPS’ time‐on‐task for 2016. County‐wide, the service’s

time‐on‐task averaged 0.8 hours per response. Time‐on‐task does not vary significantly by

station, except for Tillsonburg which is situated at a distance, at the County’s southern

boundary. For Tillsonburg ambulances, time‐on‐task averages 0.91 hours per response. 16

16 Note: An OCPS ambulance response may be cleared at a distance from the station, e.g., after dropping off a patient at London Health Sciences Centre in London. ADRS time stamps do not account for long distance return travel to base. In determining OCPS’ time-on-task, we have incorporated an adjustment of 40 minutes for long distance return travel, from hospitals situated outside of the County.



7.9 Hourly Time‐on‐Task Profile, 2016

Exhibit 7.11 presents the OCPS time‐on‐task profile by hour for calendar year 2016. The

profile, which is characteristic of other ambulance services, was developed by applying time‐

on‐task to the hourly response volumes shown previously in Exhibit 7.10, and dividing by 365.

Hourly time‐on‐task profiles by individual station are included in Appendix D.

EXHIBIT 7.11: HOURLY TIME‐ON‐TASK PROFILE FOR OCPS (2016)

7.10 Response Profile by Incident Type, 2016

Exhibit 7.12 presents the response profile by incident type, for 2016. Incident type is

categorized by the CACC call taker based on information provided by the caller.

EXHIBIT 7.12: RESPONSE PROFILE BY INCIDENT TYPE (2016)



Of note, are the following statistics. About 38% of ambulance responses are dispatched to life‐

threatening calls potentially involving: sudden cardiac arrest; chest pain; problems breathing;

stroke/CVA; seizure; poisoning; and trauma.

Calls potentially involving sudden cardiac arrest (i.e., calls requiring a rapid response and

aggressive intervention with defibrillation) account for only 1% of all ambulance responses.

Calls potentially involving stroke/CVA account for 2%.

7.11 EMS Demand by Age Cohort, 2016

Exhibit 7.13 presents two similar‐looking profiles of Oxford County’s EMS service demand for

year 2016, organized by age cohort. The service demand, which is expressed as EMS incidents

per 100 population, was extracted from OCPS’ e‐ACR database of patient contact calls that took

place in 2016.

One profile is based on population projections for 2016 by Watson & Associates, as reported in

their March 2014 report “Growth Forecast and Employment Lands (GFEL) Study”. These

projections are Oxford County Council's adopted long‐term forecasts.

The second profile is based on population projections for 2016 by Ministry of Finance (MOF), as

published in their Spring 2017 report “Ontario Population Projections Update 2016‐2041”.

As illustrated by the graphic, the County’s EMS demand is relatively low for all ages, below the

seniors age group (65+ years) whereas, within the seniors group, demand for EMS rises

exponentially by age. This relationship, between EMS demand and age, is not unique to Oxford

County. It has been affirmed by multiple other jurisdictions.

As discussed further in Section 11.1 of this report, seniors (65+ years) presently account for

18% of the County’s total population, and they generate about 50% of all land ambulance calls.

By 2031, seniors will account for 25% or more of Oxford County’s population, and they will

place considerably higher demand on OCPS’ land ambulance resources.

EXHIBIT 7.13: EMS INCIDENTS BY AGE COHORT

0

10

20

30

40

50

60

70

80

90

EMS INCIDEN

TS PER

100 POP'N (P

R 1‐4)

AGE COHORT

EMS INCIDENTS BY AGE COHORT

GFEL

MOF



8 RESPONSE TIME PERFORMANCE PLAN

8.1 Canadian Triage Acuity Scale (CTAS)

On arrival at the scene of a medical incident, and prior to any medical intervention, paramedics

will initially assess and document the patient’s condition as one of five Canadian Triage Acuity

Scale (CTAS) levels. The five CTAS categories are described below, in Exhibit 8.1. 17

EXHIBIT 8.1: CANADIAN TRIAGE ACUITY SCALE (CTAS)

CTAS CATEGORY

DESCRIPTION IDEAL TIME TO PHYSICIAN

ASSESSMENT

CTAS 1

Resuscitation

Conditions that are, or may pose, an imminent threat to life or limb

(or imminent risk of deterioration) requiring immediate aggressive

interventions, i.e., cardiac arrest, major trauma, severe respiratory

distress.

Immediate

CTAS 2

Emergent

Conditions that potentially threaten life, limb or function, requiring

rapid medical interventions or delegated acts, i.e., head injury,

severe trauma, chest pain.

Within 15

minutes

CTAS 3

Urgent

Conditions that could potentially progress to a serious problem

requiring emergency intervention. May be associated with

significant discomfort or affecting ability to function at work or

activities of daily living, i.e., assault, moderate trauma, moderate

respiratory distress.

Within 30

minutes

CTAS 4

Semi Urgent

Conditions that may be related to patient age, distress, or potential

for deterioration or complications, which would benefit from

intervention or reassurance within 1‐2 hours, i.e., minor trauma,

abdominal pain, headache, back pain.

Within 1 hour

CTAS 5

Non‐Urgent

Conditions that may be acute but non‐urgent as well as conditions

which may be attributed to a chronic problem. Interventions may be

delayed for several hours, i.e., sore throat, vomiting, minor

symptoms.

Within 2 hours

17 Sources: (1) “Implementation Guidelines for The Canadian Emergency Department Triage & Acuity Scale (CTAS)”, endorsed by the Canadian Association of Emergency Physicians (CAEP), the National Emergency Nurses Affiliation of Canada (NENA), and L'association des médecins d'urgence du Québec (AMUQ), December 1998. (2) “Revisions to the Canadian Emergency Department Triage and Acuity Scale (CTAS) Adult Guidelines”, CTAS National Working Group, Canadian Journal of Emergency Medicine (CJEM), March 2008.



8.2 Response Time Performance Plan (RTPP)

Regulation 257/00 under the Ambulance Act requires every municipality that is provincially

designated as an ambulance delivery agent, to establish a Response Time Performance Plan

(RTPP) specifying ambulance response time targets by Canadian Triage Acuity Scale (CTAS)

classification levels. The regulation also requires municipalities to report service performance

by CTAS classification; this, based on percentile achievement.

By Regulation, an RTPP plan is to be submitted to MOHLTC annually, about two months prior to

the start of each funding year; and a report on service performance is to be submitted

annually, about three months after the funding year is concluded.

RTPP targets are comprised of two components, as illustrated in Exhibit 8.2 (next page):

Specified time interval (in minutes), measured from the time a paramedic crew is notified

of a call to the time of arrival of the first crew on‐scene, and.

Fractile percentage, identifying the minimum percentage of calls within the category,

where response time will be equal to, or less, than the time interval specified.

For the CTAS 1 category, the response time interval is set by provincial Regulation at 8 minutes;

whereas, the municipality establishes the CTAS 1 fractile percentage. For CTAS 2‐5, the

municipality has the flexibility to decide on both parameters.

As an additional requirement, Regulation 257/00 also requires municipalities to report on

medical incidents involving Sudden Cardiac Arrest (SCA).

SCA incidents are a subset of the CTAS 1 classification. The Regulation does not require

municipalities to establish a separate target response time for SCA incidents, but it does

require a separate report, as follows: the municipality is to report the percentage of

occurrences, where a person equipped with a defibrillator arrives on scene to a victim of

Sudden Cardiac Arrest, within six (6) minutes of notification.

To be clear, target response times and service performance reports for the CTAS 1‐5

categories, are specific to the paramedic service, i.e., the response time clock can only be

stopped by the arrival of a paramedic. Whereas, for the Sudden Cardiac Arrest classification,

there is no regulation requiring a targeted response time, but there is a regulation requiring a

report, and that report is based on the arrival of anyone equipped with a defibrillator. More

specifically, for the SCA classification only, the response time clock can be stopped by the

arrival of anyone equipped with a defibrillator.

8.3 Oxford County’s RTPP Targets & Performance, 2013‐2017

Oxford County’s RTPP targets for funding years 2013 to 2017, are shown in Exhibit 8.2 (next

page). Oxford County has adopted the same annual RTPP targets for the past five years.

Moreover, the same targets have also been adopted for 2018.

We compared Oxford County’s RTPP targets to those of EMS peers. The peers were selected by

APEXPRO based primarily on service area population, as reported by the 2016 Census. The

Census population for Oxford County is 110,862 residents. For peer service areas, the Census



population ranges from 59,297 to 161,531 residents. The Census data is based on permanent

residents, i.e., it excludes temporary/seasonal residents.

It is our conclusion that Oxford County’s RTPP targets are generally consistent with those of

EMS peers, with values ranging at about the median value among peers, or higher.

EXHIBIT 8.2: RTPP TARGETS & PERFORMANCE, 2013‐2017

Also shown by Exhibit 8.2, from 2013 to 2016, OCPS consistently performed well relative to

their established RTPP targets by CTAS category. Based on call records year‐to‐date, it is

expected that the service will perform well again in 2017.

TARGET ‐ MINUTES TARGET ‐ PERCENT PERFORMANCE

CTAS 1 (HIGHEST URGENCY) 8 70% 72%

CTAS 2 10 80% 87%

CTAS 3 15 90% 96%

CTAS 4 15 80% 96%

CTAS 5 (NON‐URGENT) 15 80% 96%



CTAS 2 10 80% 84%

CTAS 3 15 90% 94%

CTAS 4 15 80% 94%




CTAS 2 10 80% 81%

CTAS 3 15 90% 93%

CTAS 4 15 80% 93%




CTAS 2 10 80% 82%

CTAS 3 15 90% 93%

CTAS 4 15 80% 92%




CTAS 2 10 80% 80%

CTAS 3 15 90% 92%

CTAS 4 15 80% 90%


2013 RTPP TARGETS & PERFORMANCE




2017 RTPP TARGETS & PERFORMANCE (JAN 1 ‐ AUG 31)



This notwithstanding, RTPP performance levels are declining, most noticeably in the CTAS 2 and

CTAS 3 classifications.

If performance levels continue to decline, then the County will need to re‐assess its options for

2018 and beyond. The principal option is to add additional ambulance resources, and this is

what we are recommending in Section 10 of this report.

8.4 Response Performance in the SCA Classification

Annually, response performance in the Sudden Cardiac Arrest (SCA) classification has ranged

between 35% and 52%. These figures represent the percentage of occurrences, where a

person equipped with a defibrillator arrives on scene to a victim of Sudden Cardiac Arrest

within six (6) minutes of notification.

These figures, which were reported by OCPS, are derived from available statistics on OCPS

responses, responses performed by local fire departments, and Public Access Defibrillator

(PAD) usage. The significant variance in the year‐to‐year performance results, is attributed to

relatively low call volumes in the SCA classification, where one or two outliers in any year will

significantly skew the findings.

Despite the year‐to‐year variance, the relatively low percentiles (35% to 52%) clearly illustrate

how difficult it is, to respond rapidly to SCA’s requiring urgent intervention with a defibrillator –

despite the combined efforts of EMS, Fire and PAD.

8.5 Response Profile by Call Urgency (2016)

As discussed previously, most Ontario CACCs, including London CACC, use a medical triage

software system known as “Dispatch Priority Card Index (DPCI)” to rapidly assess and assign a

dispatch priority to each incoming request.

In 2016, London CACC assessed 64% of all Oxford County ambulance requests as life‐

threatening or potential life‐threatening, where a delay in medical intervention and transport

can have an adverse effect on outcome.

The CACC dispatched these

ambulance requests as Priority

4 (highest urgency) with

flashing lights and siren – this as

shown in Exhibit 8.3.

EXHIBIT 8.3: CALLS BY DISPATCH PRIORITY (2016)

64.1%

32.6%

1.7%

1.7%

0% 20% 40% 60% 80%

PRIORITY 4 (HIGHEST URGENCY)

PRIORITY 3

PRIORITY 2

PRIORITY 1 (NON‐URGENT)

CALLS BY DISPATCH PRIORITY



On arrival at scene, the paramedics assessed and documented the patient’s condition using the

Canadian Triage Acuity Scale (CTAS).

Based on the paramedics’

assessment at scene, less than

28% of the requests required a

rapid ambulance response – this

as shown in Exhibit 8.4.

More specifically, less than 2%

were categorized as CTAS

1/SCA, requiring aggressive

intervention (defibrillation /

resuscitation); and 26% were

categorized as CTAS 2, requiring

rapid intervention to treat a

potentially threatening

situation.

On June 5th, 2017 MOHLTC announced that Ontario will be enhancing its emergency health

services system to provide people with increased flexibility and more options for medical

transportation and paramedic services.

The proposed enhancements include investment in a new medical dispatch system that will

improve the triaging and prioritization of 911 calls for ambulance service.

The new system is expected to be implemented at all provincial CACCs over the next 2 to 3

years.

EXHIBIT 8.4: CALLS BY CTAS (2016)

1.8%

25.7%

55.5%

16.9%

0% 20% 40% 60%

SCA/CTAS 1 (HIGHEST URGENCY)

CTAS 2

CTAS 3

CTAS 4 & 5 (NON‐URGENT)

CALLS BY CTAS



9 UNIT HOUR UTILIZATION (UHU)

Ambulance workload is measured by Unit Hour Utilization (UHU), which is defined as the

number of hours that an ambulance spends on task relative to the number of hours on shift.

Time‐on‐task is measured from the time that the ambulance crew is dispatched, to the time

that the paramedic is relieved of their responsibility for the patient and the call is cleared.

Time‐on‐task does not include time for discretionary activities that can otherwise be deferred if

the ambulance is needed to respond to a medical emergency, i.e., to complete documentation.

For example, if an ambulance shift is 12 hours, and during

shift the ambulance is on task attending to one or more calls

for a total of 4 hours, then its UHU is 33%. Alternatively, if

an ambulance were to spend 6 of the 12 hours, on task

attending to calls, then its UHU would be 50%.

UHU may be reported for a single ambulance, for the

service, and for any period – a shift, a day, month or year.

UHU are typically higher when, and where, call volumes are

higher, i.e., during the daytime and in urban communities.

UHU are typically lower when, and where, call volumes are

lower, i.e., at night and in rural areas.

‘High performance’ land ambulance services operate at UHU

of 25% or less. At such levels ambulance availability to

respond to the next call is 75% or better; and response times

to medical emergencies are rapid, attaining 8:59 or better at

the 90th percentile. These services are expensive to operate

and consequently, there are relatively few such services.

Experience shows that it is undesirable to operate at UHU

over 40%, since at such levels, there would be little capacity‐

in‐reserve for overlapping calls, ambulance availability for

the next call would be less than 60%, and service response

times would be lengthy.

Leading (best) practices suggest targeting to an annual UHU

of 35% or less. At this level, ambulance availability for the

next call is 65% or better and service response times are

reasonable. Many Ontario EMS services operate at about a

35% UHU.

Recommendation: Oxford County should adopt an annual UHU of 35% as its preferred, upper

limit service level target for the County’s land ambulance stations. At this UHU the likelihood

that each station will have at least one ambulance available to respond to the next call will be

65% or better, and station response times will improve beyond current levels, shown in Exhibit

10.1 (next page).

UNIT H

OUR U

TILIZATION

AVAILABILITY F

OR NEXT C

ALL

25% 75%

35% 65%

30% 70%

40% 60%

45% 55%

50% 50%

R E S P O N S E D E L A Y S

R A P I D R E S P O N S E

UNIT HOUR UTILIZATION

RESPONSE TIM

E



10 NEAR‐TERM RESOURCING REQUIREMENTS

10.1 Current (2016) Performance Summary

Hourly Unit Hour Utilization (UHU) profiles for the service, and by station, are shown in

Appendix E.

Presented below, in Exhibit 10.1, is a performance summary for OCPS, showing annual UHU,

ambulance availability, and 90th percentile response times for 2016. UHU and ambulance

availability are based on ambulance responses that CACC dispatched as Priority 1‐4 and 8; 90th

percentile response times are for Priority 4 ambulance responses.

UHU that measure up to industry leading practices are shown in black font. Those that vary

substantially from industry leading practices, are shown in red, as are their corresponding

performance attributes.

EXHIBIT 10.1: PERFORMANCE SUMMARY BY STATION (2016)

Day: 07:00‐19:00 hours Night: 19:00‐07:00 hour

Service‐wide, UHU for Oxford County Paramedic Service measure up closely to industry leading

(best) practices. In 2016, the annual UHU daytime was 37%, and the annual UHU at night was

lower, as would be expected.

Ambulance stations operating in Woodstock, Ingersoll and Tillsonburg, also report values that

measure up to industry leading (best) practices, with daytime UHU of 31% to 36%, and lower

UHU at night.

In contrast, for ambulance stations operating in the rural townships (Norwich, Blandford‐

Blenheim and Zorra), where there is substantially less population and substantially less demand

for EMS services, the workload data varies unexpectedly.

Instead of operating at UHU which are lower than those of the urban centres (as one would

expect), their UHU are inordinately higher, measuring 45% during the day and 51% at night.

At these UHU, the likelihood that a rural‐based ambulance will be at hand in its primary

coverage zone when a medical emergency arises, is only 55% during the day, and even worse,

at night, at 49%.

DAY NIGHT DAY NIGHT

WOODSTOCK 00 & 01 33% 31% 67% 69%

INGERSOLL 02 31% 28% 69% 72%

TILLSONBURG 03 36% 28% 64% 72%

NORWICH 04, DRUMBO

05 & EMBRO 0745% 51% 55% 49%

OCPS 37% 35% 63% 65%

ANNUAL UHU AVAILABILITY

(90TH PERCENTILE) FOR NEXT CALL90TH PERCENTILE

RESPONSE TIME

(BY STATION)

11:31

09:43

11:44

08:47

14:05



These statistics also help to explain why 90th percentile response times in the rural townships

range upwards of 19:57 (as discussed previously in Section 7.4), whereas OCPS stations, in our

opinion, are well‐situated to provide County residents with more rapid ambulance response

times of 10 to 15 minutes, or less (as discussed in Section 12.4).

This urban‐rural workload imbalance is attributed to the unusually large volume of responses,

which rural‐based ambulances perform for areas other than their primary coverage zones. As

previously discussed in Section 7.6, in 2016 rural‐based ambulances responded to only 1,200

calls in their own coverage zones, whereas they attended almost 8 times as many calls

elsewhere, including 7,500 standby postings and 1,500 calls for service in the urban centres.

In prior years, when urban centre call volumes were lower, the County’s reliance on rural

ambulances to cover both rural townships and urban centres, worked well, since rural

ambulances were called upon less frequently. Today, the practice does not work as was

originally intended. Rapidly rising EMS demand in the urban centres is exacerbating land

ambulance deployment, and rural ambulances are frequently called on to perform standby

emergency coverage.

The County’s reliance on rural ambulances to cover both rural townships and urban centres, is

also skewing the true workload of urban‐based ambulances, since numerous calls are being

offloaded. We estimate that, without the rural ambulances’ support, the workload of

ambulances based in the urban centres would be higher than the figures reported in Exhibit

10.1, by 15% or more, thus encroaching undesirable UHU of 40% or more (as currently exist in

the rural townships); and urban ambulance availability to attend medical emergencies would

be reduced by a corresponding amount.

While 2017 statistics are not readily available, it is our opinion based on rising call volume

trends, that 2017 ambulance UHU are higher than those reported in this document for 2016,

and by extension ambulance availability is lower. Further, response volumes are projected to

continue to increase over the next 10 to 15 years, and this will only exacerbate the ambulance

workload/availability situation.

Recommendations

In our opinion, the urban‐rural workload imbalance needs to be resolved – preferably in the

near term (2018), if financially feasible.

To this end, we recommend that urban centres of the County be made more self‐sufficient.

More specifically, the County should staff additional ambulance resources in urban centres of

highest call concentration (Woodstock and Tillsonburg), as discussed below in Sections 10.2 to

10.4.

These corrective actions will not only reduce the volume of rural ambulance responses in the

urban centres, they will also substantially improve ambulance availability in the rural townships

of the County, and shorten response times to medical emergencies arising therein.



10.2 Option 1 – Increase Ambulance Staffing in Tillsonburg

The Tillsonburg station (#03) presently operates with 2 ambulances. One ambulance is staffed

24 hours a day, 7 days a week. The other is staffed a 10‐hour daytime shift, on weekdays.

Option 1 is to increase the Tillsonburg weekday car coverage from 10/5 to 24/7, so that

Tillsonburg station would operate with 2 ambulances, each staffed 24/7.

As shown by Exhibit 10.2, we estimate that if this option were implemented, it would reduce

the need for rural ambulance standby in Tillsonburg, and improve ambulance availability in the

rural Townships by 4% in the daytime and 10% at night. In addition, response times at the 90th

percentile would be improved as follows: by about 1 minute at Tillsonburg station; by half a

minute at the rural stations; and by half a minute service‐wide.

EXHIBIT 10.2: INCREASE AMBULANCE STAFFING IN TILLSONBURG

10.3 Option 2 – Increase Ambulance Staffing in Woodstock

The City of Woodstock is covered by two ambulance stations (Mill #00 and Bysham #01). Each

station staffs one ambulance on days, and one ambulance at night. Option 2 is to implement

an additional daytime ambulance, so that the City would be covered by 3 ambulances on days

and 2 at night. Day and night shift durations would remain 12 hours a piece.

EXHIBIT 10.3: INCREASE AMBULANCE STAFFING IN WOODSTOCK

DAY NIGHT DAY NIGHT

WOODSTOCK 00 & 01 33% 31% ‐‐ ‐‐

INGERSOLL 02 31% 28% ‐‐ ‐‐

TILLSONBURG 03 32% 16% + 4% + 12%

NORWICH 04, DRUMBO

05 & EMBRO 0741% 41% + 4% + 10%

OCPS 35% 28% + 2% + 7%

APPROX. IMPROVEMENT

IN 90TH PERCENTILE

RESPONSE TIME

‐‐

‐‐

1 MINUTE

0.5 MINUTE

AVAILABILITY

0.5 MINUTE

ANNUAL UHU IMPROVEMENT IN

(90TH PERCENTILE)

DAY NIGHT DAY NIGHT

WOODSTOCK 00 & 01 27% 31% + 6% ‐‐

INGERSOLL 02 31% 28% ‐‐ ‐‐

TILLSONBURG 03 36% 28% ‐‐ ‐‐

NORWICH 04, DRUMBO

05 & EMBRO 0734% 51% + 11% ‐‐

OCPS 31% 35% + 6% ‐‐


(90TH PERCENTILE) AVAILABILITYAPPROX. IMPROVEMENT

IN 90TH PERCENTILE

RESPONSE TIME

0.25 MINUTE

‐‐

‐‐

0.75 MINUTE

0.5 MINUTE



As shown by Exhibit 10.3 (previous page), we estimate that if this option were implemented, it

would reduce the need for rural ambulance standby in Woodstock, and improve ambulance

availability in the rural townships by 11% in the daytime. In addition, response times at the

90th percentile would be improved as follows: by about three quarters of a minute at the rural

stations; and by half a minute service‐wide.

Due to the present scarcity of spare ambulances, to implement this option the County would

need to purchase an additional, fully‐equipped ambulance. This additional ambulance can be

stationed at the Mill Street base, where there is ample spare garage capacity.

10.4 Option 3 (Recommended)

As shown by Exhibit 10.4, we estimate that if both options were implemented, they would

reduce the need for rural ambulance standby in both Tillsonburg and Woodstock; they would

improve ambulance availability in the rural Townships by 15% in the daytime and 10% at night;

and response times at the 90th percentile would be improved by about 1.25 minutes at the

rural stations, and by about 1‐minute service‐wide.

EXHIBIT 10.4: RECOMMENDED OPTION

Recommendations

In consideration of the above information we recommend that both Options 1 and 2 be

implemented, specifically:

The Tillsonburg weekday car coverage should be increased from 10/5 to 24/7, so that

Tillsonburg station would operate with 2 ambulances, each staffed 24/7.

An additional daytime ambulance should be implemented in the City of Woodstock, so that

the City would be served by 3 ambulances on days and 2 at night. For such purposes, the

County will need to purchase an additional, fully‐equipped ambulance. This additional

ambulance can be stationed at the Mill base, where there is ample spare garage capacity.

If financially feasible, both Options 1 and 2 should be implemented in the near‐term – in 2018.

As shown by Exhibit 10.4, the UHU of rural‐based ambulances will still be high at night, at 41%.

We recommend that this be reduced further, by staffing the Drumbo ambulance for the entire

night. Currently, that ambulance is not staffed from 02:00 to 06:00 hours.

DAY NIGHT DAY NIGHT

WOODSTOCK 00 & 01 27% 31% + 6% ‐‐

INGERSOLL 02 31% 28% ‐‐ ‐‐

TILLSONBURG 03 32% 16% + 4% + 12%

NORWICH 04, DRUMBO

05 & EMBRO 0730% 41% + 15% + 10%

OCPS 29% 28% + 8% + 7%


(90TH PERCENTILE) AVAILABILITY

1 MINUTE

APPROX. IMPROVEMENT

IN 90TH PERCENTILE

RESPONSE TIME

0.25 MINUTE

‐‐

1 MINUTE

1.25 MINUTES



11 LONG‐TERM (15‐YEAR) DEMAND FORECASTS

11.1 Key Drivers of Service Demand

Population growth, and particularly seniors’ population growth (65+ years), are the principal

drivers of land ambulance service demand. Exhibits 11.1 presents two long‐term forecasts of

future population for Oxford County.

One forecast, which is extracted from the recently published “Ontario Population Projections

Update 2016‐2041, Spring 2017”, prepared by Ministry of Finance (MOF), projects that the

County’s population will increase at an average annual rate of about 0.7%.

The other forecast ‐ which Oxford County adopted as its long‐term forecast ‐ was developed by

Watson & Associates, and reported in their March 2014 report “Growth Forecast and

Employment Lands (GFEL) Study”. The GFEL forecast projects that the County’s population will

increase at a slightly lower rate of 0.6% per annum.

Exhibit 11.2 presents the

corresponding growth forecasts

for seniors’ population, aged 65+

years.

Both MOF and GFEL forecast a

relatively rapid rise in seniors

population, of about 3% per

annum, i.e., a rate which is 4 to 5

times faster than the growth in

total population.

This rapid increase in seniors

population is not unique to

Oxford County. Similar trends

are reported by multiple other

jurisdictions.

Seniors (65+ years) presently

account for 18% of the County’s

total population, and they

generate about 50% of all land

ambulance calls.

By 2031, seniors will account for

25% or more of the County’s

population, at which time they

will place considerably higher

demand on OCPS’ land

ambulance resources.

EXHIBIT 11.1: POPULATION FORECASTS FOR OXFORD COUNTY

EXHIBIT 11.2: SENIORS POPULATION FORECASTS (65+ YEARS)

2011 2016 2021 2026 2031 2036

GFEL 108,200 111,700 115,500 118,800 121,900 124,200

MOF 108,200 112,300 116,600 120,500 123,900 126,700

95,000

100,000

105,000

110,000

115,000

120,000

125,000

130,000

POPULA

TION

POPULATION FORECASTS FOR OXFORD COUNTY

2011 2016 2021 2026 2031 2036

GFEL 16.2% 17.9% 20.1% 22.5% 25.3% 26.6%

MOF 16.2% 18.4% 20.9% 24.0% 27.1% 28.6%

0%

5%

10%

15%

20%

25%

30%

35%

% O

F TO

TAL POPULA

TION

SENIORS POPULATION FORECASTS (65+ YEARS)



11.2 Long‐Term (15‐Year) Service Demand Forecasts

Exhibit 11.3 presents three long‐term forecasts of future EMS demand for Oxford County.

APEXPRO developed these forecasts, as described below.

EXHIBIT 11.3: AMBULANCE RESPONSE FORECASTS

The ‘high growth’ forecast is a forward looking trend line extrapolation of changes in response

volume, 2011 to 2016. This forecast projects that high priority response volumes (i.e.,

ambulance responses dispatched as Priority 3 and 4) will continue to increase at the current

rate of 5.3% per annum; and that the total response volume (Priority 1‐4 and 8) will increase to

38,100 by 2031 (up from 22,650 in 2016).

The ‘medium growth’ forecast is based on a regression analysis of changes in response volume,

2011 to 2016, relative to population changes in the same period. The results are projected

forward using the MOF long‐term population forecast. This forecast projects that high priority

response volumes will increase at 5% per annum; and that the total response volume (Priority

1‐4 and 8) will increase to 35,700 by 2031, at which point the rate of increase will begin to

slow, reflecting a projected decrease in the pace of seniors growth around that period.

The ‘low growth’ forecast is also based on a regression analysis of changes in response volume,

2011 to 2016, relative to population changes in the same period; however, in this instance, the

results are projected forward using the GFEL long‐term population forecast. This forecast

projects that high priority response volumes will increase at 4.6% per annum; and that the total

response volume (Priority 1‐4 and 8) will increase to 33,000 by 2031, at which point it too will

begin to slow, reflecting a projected decrease in the pace of seniors growth around that period.

Our forecasts of long‐term EMS resourcing needs, discussed in Section 12 of this report, is

based on the ‘low growth’ EMS demand forecast for Oxford County.

2011 2016 2021 2026 2031 2036

HIGH 18,229 22,650 26,500 31,600 38,100 46,400

MEDIUM 18,229 22,650 26,000 30,800 35,700 38,700

LOW 18,229 22,650 24,800 28,700 33,000 35,400

0

10,000

20,000

30,000

40,000

50,000

RES

PONSE

S (PR 1‐4 & 8)

AMBULANCE RESPONSE FORECASTS



11.3 Geographic Distribution of Future EMS Demand

Exhibit 11.4 presents a series of heat maps showing the current (2016) and forecast distribution

of EMS demand across Oxford County by call density, ranging from urban centres of high call

concentration (in red) to rural areas of low call concentration (in grey).

The heat maps are derived from the ‘low growth’ forecast, discussed previously in Section 11.2,

which projects EMS demand within the County to increase by +9% to 2021; by +27% to 2026;

and by +46% to 2031.

The City of Woodstock is expected to generate 55% of all new calls over the next 15 years.

Tillsonburg is expected to generate 15%, and Ingersoll 10%.

EXHIBIT 11.4: GEOGRAPHIC DISTRIBUTION OF FUTURE EMS DEMAND

The base map was supplied by the Information Services department of the County of Oxford.



12 LONG‐TERM (15‐YEAR) RESOURCING NEEDS

Our forecasts of OCPS’ long‐term (15‐year) resourcing needs, are based on the ‘low growth’

EMS demand forecast for Oxford County (discussed in Section 11.2), and an annual UHU of 35%

as the preferred upper limit service level target for the County’s land ambulance stations.

If EMS demand increases at a faster pace, then the requirement for additional ambulance

resources will increase more rapidly. Conversely, if EMS demand increases at a slower pace,

then so also will the requirement for more resources slow down.

Recommendation: We therefore recommend that OCPS should monitor year‐over‐year call

volume changes, and periodically adjust the forecast level of resourcing in tandem.

12.1 Forecast Coverage Requirements – Daytime

Daytime coverage currently peaks at 8 staffed ambulances on weekdays, and 7 on weekends.

The long‐term daytime coverage requirement, as shown in Exhibit 12.1, is forecast to be 11

staffed ambulances, each to operate 12/7.

EXHIBIT 12.1: FORECAST COVERAGE REQUIREMENTS – DAYTIME

The long‐term forecast includes the near‐term recommendations set out previously in Section

10.4. These are spread over two years, 2018‐2019; to soften the near‐term financial impact.

2018: Expand Tillsonburg daytime coverage to include 2 staffed ambulances on weekends;

this, in lieu of 2 staffed ambulances on weekdays and 1 on weekends.

2019: Increase Woodstock daytime coverage to 3 staffed ambulances (up from current 2).

2029: Expand the daytime coverage at Tillsonburg to 3 staffed ambulances.

2030: Expand the daytime coverage in Woodstock to 4 staffed ambulances.

2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031

TOTAL 8 8 9 9 9 9 9 9 9 9 9 9 10 11 11

RURALS (04, 05 & 07) 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

TILLSONBURG (03) 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3

INGERSOLL (02) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

WOODSTOCK (00 & 01) 2 2 3 3 3 3 3 3 3 3 3 3 3 4 4

0

2

4

6

8

10

12

STAFFED AMBULA

NCES

FORECAST COVERAGE REQUIREMENTS ‐ DAY PEAK



12.2 Forecast Coverage Requirements – Night Time

Night‐time coverage currently is 6 staffed ambulances (only 5 between 02:00 and 06:00 hours).

The long‐term requirement, as shown in Exhibit 12.2, is forecast to be 8 staffed ambulances

night‐time, each to operate 12/7.

EXHIBIT 12.2: FORECAST COVERAGE REQUIREMENTS – NIGHT TIME

The long‐term forecast includes the near‐term recommendations set out previously in Section

10.4. These are spread over two years, 2018‐2019; to soften the near‐term financial impact.

2018: Expand the night‐time coverage at Tillsonburg to 2 staffed ambulances (up from

current 1).

2019: Expand the night‐time coverage at Drumbo (Blandford‐Blenheim) to a full 12‐hour

shift. Currently, the Drumbo ambulance is not staffed from 02:00 to 06:00 hours.

2030: Expand the night‐time coverage in the rural townships to 3 staffed ambulances (up

from current 2).

12.3 Forecast Fleet Requirements

OCPS currently operates with 12 and 4 command vehicles. The long‐term requirement, as

shown in Exhibit 12.3 (next page), is forecast to be 17 fully‐equipped ambulances and 4

command vehicles.

The 5 additional fully‐equipped ambulances, include: +1 spare ambulance in 2019; +2

ambulances for Woodstock (one in each of 2019 and 2030); +1 ambulance in 2029 for

Tillsonburg; and +1 ambulance in 2030 for the rural townships.

Additional details are provided below.

2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031

TOTAL 6 7 7 7 7 7 7 7 7 7 7 7 7 8 8

RURALS (04, 05 & 07) 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3

TILLSONBURG (03) 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2

INGERSOLL (02) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

WOODSTOCK (00 & 01) 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

0

2

4

6

8

10

12

STA

FFED

AMBULA

NCE

S

FORECAST COVERAGE REQUIREMENTS ‐ NIGHT TIME



2019: OCPS to acquire an additional fully‐equipped spare ambulance, as previously

recommended in Section 4.4.

2019: Woodstock daytime coverage to be increased to 3 staffed ambulances, as previously

recommended in Section 12.1. An additional fully‐equipped ambulance will be needed for

this purpose.

2029: Tillsonburg daytime coverage to be increased to 3 staffed ambulances, as previously

recommended in Section 12.1. An additional fully‐equipped ambulance will be needed for

this purpose.

2030: Woodstock daytime coverage to be increased to 4 staffed ambulances, as previously

recommended in Section 12.1; and night‐time coverage in the rural townships to be

increased to 3 staffed ambulances, as previously recommended in Section 12.2. Two (2)

additional fully‐equipped ambulances will be needed for such purposes.

EXHIBIT 12.3: FORECAST FLEET REQUIREMENTS

12.4 Long‐Term Station Locations

Exhibit 12.4 (next page) contains a map showing response coverage capabilities by ambulances

based at the County’s ambulance stations at 10, 15, 20, 25 and 30‐minute intervals.

The response contours presented by the graphic, are estimated values, which we derived using

a GIS mapping database supplied by the Information Services department of the County of

Oxford. Our analysis assumes a station chute time (T2‐T3) of one (1) minute, and drive times

based on the posted roadway speed limits.

2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031

TOTAL 12 12 14 14 14 14 14 14 14 14 14 14 15 17 17

SPARES 4 4 5 5 5 5 5 5 5 5 5 5 5 5 5

RURALS (04, 05 & 07) 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4

TILLSONBURG (03) 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3

INGERSOLL (02) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

WOODSTOCK (00 & 01) 2 2 3 3 3 3 3 3 3 3 3 3 3 4 4

0

2

4

6

8

10

12

14

16

18

AMBULA

NCES

FORECAST FLEET REQUIREMENTS



We draw the following conclusions from

the simulation:

OCPS stations are well‐situated to

provide residents of the three urban

centres (Woodstock, Ingersoll and

Tillsonburg) with ambulance

response times of 10 minutes or less.

OCPS stations are well‐situated to

provide many rural township

residents with ambulance response

times of 10 minutes or less, and

almost all rural township residents

with ambulance response times of 15

minutes or less.

These simulated findings vary from actual

OCPS response times, due to such factors

as: ambulance availability at the time of

the medical emergency; ambulance’s

actual speed; overall volume of traffic on

the road; and road and weather

conditions.

The above notwithstanding, the simulated findings support the response time data presented

previously in Section 7.4 of this report. As discussed therein, in 2016, the 90th percentile

response times for Woodstock, Ingersoll and Tillsonburg, ranged between 07:47 and 08:24. For

the rural townships, they ranged between 11:57 and 19:57; and County‐wide, it was 11:31.

OCPS currently operates with 12 fully‐equipped ambulances, whereas, as discussed previously

in Section 12.3, the long‐term (15‐year) requirement is estimated at 17 ambulances, as follows:

2 additional fully‐equipped ambulances in the near‐term (circa 2019). This includes +1

spare ambulance, and +1 additional ambulance for Woodstock.

3 additional fully‐equipped ambulances in the long‐term (circa 2029/2030). This includes

+1 additional ambulance for Woodstock, +1 additional ambulance for Tillsonburg, and +1

additional ambulance for the rural townships.

While existing OCPS stations cannot fully accommodate the long‐term requirement for 5

additional ambulances, they can accommodate up to 4 additional ambulances, as follows.

Mill Street station presently has space for 1 additional ambulance – and can accommodate up

to 2 additional ambulances, if a command vehicle is relocated elsewhere. Tillsonburg station

also has space for 1 additional ambulance – and can accommodate up to 2 additional

ambulances, if the Emergency Support Unit, which is situated therein, is relocated elsewhere.

EXHIBIT 12.4: EMS RESPONSE COVERAGE (2016)



Presented below are two alternative options for addressing the long‐term fleet requirements.

These options are based on the long‐term EMS demand forecast for Oxford County, which

indicates that the City of Woodstock will generate 55% of all new EMS demand – which is well

in excess of the demand to be generated by Tillsonburg, Ingersoll, or the rural townships.

Option 1 is to maintain both Mill station (#00) and Bysham station (#01), and to build a

new 3rd station in the City of Woodstock, capable of housing a minimum of 2 ambulances.

Option 2 is to maintain Mill station (#00), and to replace Bysham (#01) with a new station

in the City of Woodstock, capable of housing a minimum of 4 ambulances.

The preferred locations for these potential stations is shown in Exhibit 12.5.

The reader is reminded that our analysis is based on a ‘low growth’ EMS demand forecast for

Oxford County.

If EMS demand increases at a faster pace, then the requirement for additional ambulance

resources will increase more rapidly. Conversely, if EMS demand increases at a slower pace,

then so also will the requirement for more resources slow down. We therefore have

recommend that OCPS should monitor year‐over‐year call volume changes going forward, and

periodically adjust the forecast level of resourcing in tandem.

EXHIBIT 12.5: LONG‐TERM STATION OPTIONS



13 EMS COST FORECASTS

13.1 Near‐Term Service Enhancements: Front Line

Recommended near‐term service enhancements for the front‐line operations are summarized

in Exhibit 13.1. The recommendations are listed in priority sequence. Each recommendation is

cross‐referenced to the relevant section of this report.

The recommendations are spread over two years, 2018 and 2019; this, to soften the near‐term

financial impact. Costs are presented in 2017 dollars. They are the gross costs, which are

potentially eligible for MOHLTC subsidy at 50%.

EXHIBIT 13.1: NEAR‐TERM RECOMMENDATIONS IN PRIORITY SEQUENCE


REQ’T EST.

OPERATING COST EST.

CAPITAL COST

1. 2018: Two (2) full‐time paramedics should be recruited to staff ambulances at night (in lieu of Supervisors)

‐ Approved by Council in December 2017

‐ Restores in‐the‐field supervision / will improve unit availability and reduce code criticals


2 FTE $220,000 / year ‐‐


‐ Will increase deployment to four 12‐hour shifts, up from current 2.6 [1 amb 24/7 and another 10/5]

‐ Response time to improve by about 1 minute in Tillsonburg, and 0.5 minute in the rural townships


7.7 FTE $966,000 / year ‐‐


‐ Presently operates w’ 1 daytime ambulance, 12/7

‐ Building on Rec’n #2, rural response time to improve by about 1.25 minutes, and by 1 minute County‐wide


5.5 FTE $690,000 / year


equipped ambulance

$50,000 Capital

replacement

…. / cont’d




REQ’T EST.

OPERATING COST EST.

CAPITAL COST

4. 2019: Increase deployment at Drumbo station in Blandford‐Blenheim, from 20/7 to 24/7

‐ To fill night‐time hours 02:00 to 06:00

‐ Will further improve rural service levels at night


1.8 FTE $227,700 / year ‐‐

5. 2019: Increase the fleet by one (1) additional, fully‐equipped spare ambulance

‐ Ambulance availability is often strained because 1 to 2 ambulances are frequently out of service


‐‐ ‐‐


equipped ambulance

$50,000 Capital

replacement

13.2 Near‐Term Service Enhancements: Internal Support

The following recommended near‐term enhancements are intended to improve internal

support services.

EXHIBIT 13.2: INTERNAL SUPPORT SERVICE ENHANCEMENTS

INTERNAL SUPPORT SERVICE ENHANCEMENTS FTE

REQ’T EST.

OPERATING COST EST.

CAPITAL COST

1. 2018: A Performance Analyst should be recruited as a full‐time OCPS resource

‐ To assemble and analyze EMS operations‐related statistical data that will be used to improve the services

‐ Currently there is no such in‐service capability


1 FTE $120,000 / year ‐‐

2. 2019: In‐service Logistics support should be augmented by at least 0.5 FTE

‐ These functions are the responsibility of a Supervisor/Deputy Chief, supported by a Coordinator of EMS Logistics

‐ The workload exceeds their combined capacity, and they frequently request assistance from others


0.5 FTE $60,000 / year ‐‐



13.3 EMS Operating Budget, 2018

On December 18, 2017 Oxford County Council approved a 3% increase in the EMS operating

budget, bringing it to $11.68 million for 2018 (as shown in Exhibit 13.3). The increase includes:

1.5% cost of living adjustment (COLA)

2 additional full‐time paramedics to staff ambulances at night (in lieu of Supervisors).

The approved 2018 budget excludes the following recommendations for 2018, per Exhibits

13.1 and 13.2.

Increase deployment in Tillsonburg to two (2) ambulances, each operating 24/7. This will

require 7.7 additional FTE. The estimated cost is $966,000 per annum.

A Performance Analyst should be recruited as a full‐time OCPS resource. The estimated

cost is $120,000 per annum.

Recommendation: It is our opinion that these resourcing enhancements are needed in the

near term. We recommend, that if financially feasible, they should be addressed mid‐term

2018. Alternatively, we recommend that they should be considered for 2019.

EXHIBIT 13.3: OCPS BUDGET INCREASE 2017‐2018

In 2016 Oxford County’s spending on land ambulance services was about $95 per resident. For

peers, the annual spending was on average 25% higher, with most ranging between $103 and

$159 per resident. In 2017, the County’s spending on land ambulance services was about $98

2017 2018 $ %

SALARIES & BENEFITS

SALARIES $6,966,260 $7,216,292 $250,032

BENEFITS $1,739,201 $1,839,335 $100,134

$8,705,461 $9,055,627 $350,166 4%

OTHER EXPENSES

PROGRAMMING $2,080,761 $1,992,676 ($88,085)

VEH'S & EQUIP'T CAPITAL $557,650 $630,000 $72,350

$2,638,411 $2,622,676 ($15,735) ‐1%

GROSS EXPENSES $11,343,872 $11,678,303 $334,431 3%

REVENUE

PROVINCIAL GOV'T ($5,486,389) ($5,621,259) ($134,870)

OTHER SOURCES ($171,000) ($178,000) ($7,000)

TOTAL REVENUE ($5,657,389) ($5,799,259) ($141,870) 3%

MUN'L SHARE OF EXPENSES $5,686,483 $5,879,044 $192,561 3%

EMS BUDGET CHANGE 2017‐18



per resident; and with the approved increase in budget for 2018 it will be about $101 per

resident.

13.4 Long‐Term Forecast of OCPS Operating Costs

Exhibit 13.4 (next page) presents our long‐term forecast of future OCPS operating costs to

2031. The forecast reflects County Council’s approval of 2 additional full‐time paramedics in

2018, and it assumes that the other resourcing recommendations for 2018 will be implemented

in 2019.

Costs are presented in 2017 dollars. They are the gross costs, which are potentially eligible for

MOHLTC subsidy at 50%.

Incremental in‐year cost adjustments are set out in Exhibit 13.5 (also next page). Relevant

assumptions are listed below:

5.5 FTE are needed to staff an ambulance 12/7

11 FTE are needed to staff an ambulance 24/7

Incremental annual cost to staff a 12‐hour ambulance shift is $690,000 a year

Capital cost of a fully‐equipped XL3 hybrid ambulance is $290,000

Vehicles and equipment are retired on a 6‐year life cycle

2018 budget includes a reserve contribution of $773,750 for vehicle and equipment

replacement.

13.5 Long‐Term Cost Forecast for Fleet Expansion

OCPS currently operates with 12 fully‐equipped ambulances. We have identified a

requirement for 5 additional fully‐equipped ambulances within 15 years. This will increase the

fleet size to 17 ambulances:

2 additional fully‐equipped ambulances in the near‐term (circa 2019). This includes +1

spare ambulance, and +1 additional ambulance for Woodstock.

1 additional fully‐equipped ambulance for Tillsonburg (circa 2029).

2 additional fully‐equipped ambulances (circa 2030). This includes +1 additional

ambulance for Woodstock, and +1 additional ambulance for the rural townships.

The current capital cost of a fully‐equipped XL3 hybrid ambulance is $290,000. The cost of the

5 additional fully‐equipped ambulances is estimated to be $1,450,000 (in 2017 dollars).

Provincial funding policy requires EMS services to depreciate ambulance capital costs over the

life of the vehicle. Annual depreciated costs are eligible for MOHLTC subsidy at 50%.



EXHIBIT 13.4: COST FORECAST FOR LAND AMBULANCE OPERATIONS

EXHIBIT 13.5: INCREMENTAL COST ADJUSTMENTS

Costs presented in the above exhibits are in 2017 dollars. They are the gross costs, which are potentially eligible

for MOHLTC subsidy at 50%.

2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031

PRIOR YEAR BUDGET ‐ ($M) $11.34 $11.68 $13.84 $13.84 $13.84 $13.84 $13.84 $13.84 $13.84 $13.84 $13.84 $13.84 $14.58 $16.06

INCREMENTAL ADJUSTMENTS

COLA & OPERATIONAL ADJUSTMENTS $0.12

NEAR‐TERM RESOURCING ($M)

2 PARAMEDICS FOR NIGHT SHIFTS $0.22

TILLSONBURG: EXP. 2ND CAR TO 24/7 $0.97

WOODSTOCK: ADD A DAY CAR 12/7 $0.69

DRUMBO: EXPAND CAR TO 24/7 $0.23

ANALYTIC SUPPORT $0.12

LOGISTICS SUPPORT $0.06

LONG‐TERM RESOURCING ($M)

TILLSONBURG: ADD A DAY CAR 12/7 $0.69

WOODSTOCK: ADD A DAY CAR 12/7 $0.69

RURAL: ADD A NIGHT CAR 12/7 $0.69

FLEET & EQUIP'T REPLACEMENT ($M) $0.10 $0.05 $0.10

TOTAL INCREMENTAL ($M) $0.34 $2.16 $0.74 $1.48

PROJECTED EXPENDITURE ($M) $11.68 $13.84 $13.84 $13.84 $13.84 $13.84 $13.84 $13.84 $13.84 $13.84 $13.84 $14.58 $16.06 $16.06



14 CURBING COSTS / SUSTAINING SERVICE EXCELLENCE

APEXPRO was asked to investigate Community Paramedicine, as an option by which to curb

future resourcing needs, and future cost escalations, without adversely impacting service

excellence.

14.1 Community Paramedicine

Community Paramedicine is a provincially sponsored program in which paramedics go beyond

their usual emergency response role, to connect patients in need of ongoing care support –

such as seniors, individuals with mental health issues, and persons living with chronic health

conditions ‐ to alternative home‐based care services, or community‐based care services, that

are more appropriate to their needs.

In past, all such patients were transported by ambulance to overcrowded hospital emergency

departments. Under provincially sponsored Community Paramedicine programs, paramedics

collaborate with healthcare and social service providers, to redirect low acuity patients (those

with non‐urgent needs) to more appropriate care resources closer to home and in the

community.

The Ontario government has invested almost $18 million to support the development and

expansion of Community Paramedicine programs across Ontario since 2014. The

Government’s current year investment in Community Paramedicine projects is estimated at $6

million province‐wide.

According to provincial media releases, since 2014, Community Paramedicine programs have

successfully benefited over 21,000 patients, and resulted in over 44,000 completed patient

assessments and over 5,000 referrals to appropriate health care services closer to home and in

the community. In addition, these programs have helped seniors and at‐risk individuals live

safely in their own homes, with fewer documented incidents of medical crisis for patients with

chronic conditions, and fewer accidents resulting from preventable causes.

Similar results have been reported by community paramedicine programs in Australia, the

United Kingdom, the United States and other Canadian jurisdictions, where it has been

concluded that Community Paramedicine services are feasible, safe and effective in delivering

healthcare, at high levels of patient satisfaction; and that they also help to reduce healthcare

costs, including EMS costs, by reducing unnecessary ambulance transport to hospital facilities.

Positive benefits such as those above, have been sufficiently compelling for the Ontario

Government to: incorporate Community Paramedicine as a key health care strategy in the

“Ontario 2015 Action Plan for Health Care”; reaffirm its support and funding for Community

Paramedicine programs province‐wide; and introduce proposed legislative changes (Bill 160),

which if passed, will provide paramedics with increased flexibility to deliver alternative, non‐

hospital care options on‐scene.

About half of Ontario’s paramedic services participate in Community Paramedicine of one form

or another.



CREMS, which stands for Community Referral EMS, is the most widespread Community

Paramedicine program both in Ontario, and in other jurisdictions. CREMS is intended to help

patients in need of ongoing care support, to obtain that ongoing support from an appropriate

community‐based care provider.

The way it works is that, following an emergency ambulance response, if the paramedics

believe that the patient requires ongoing care support, then with the patient’s permission, they

will refer the case to an appropriate health care or social service agency within the community.

Reasons for a CREMS referral may include: failure to thrive, occupancy safety issues (falls),

mental health (dementia and confusion), substance abuse, mobility issues, isolation and

frequency of 911 calls for ambulance services.

Ontario EMS services that participate in CREMS Community Paramedicine programs include

those based in Windsor‐Essex, London‐Middlesex, Grey County, Guelph‐Wellington, Toronto,

Hamilton, Niagara, York Region, to name a few.

Listed below are other, less common Community Paramedicine programs that have/are being

trialed by several Ontario‐based EMS services.

PERIL: Peril stands for Paramedics Assessing Elders at Risk of Independence Loss. Studies

have shown that 20% of persons over 65, and 44% of persons over 85, lack the support

they need to function independently. Following an emergency ambulance response, if the

paramedics feel that the patient requires additional support, they will refer the case

appropriately.

EPIC: Epic stands for Enhancing Paramedicine in the Community. EPIC is a clinical trial that

is investigating the effectiveness of Community Paramedicine in reducing the number of

emergency room visits by patients with specific chronic diseases, i.e., those specifically

suffering from congestive heart failure, diabetes, or chronic obstructive pulmonary

disorder.

Paramedics, in collaboration with other health care professionals, staffing Community

Wellness Clinics, to assess patients, provide routine health services (i.e., check blood

pressure or blood glucose), and deliver healthy living/chronic disease prevention

education. Such clinics are typically set up for vulnerable and hard‐to‐reach sectors of the

population.

Extended Care Paramedics who, on responding to a non‐urgent call in a nursing home, or

private residence, will not only assess, but also treat the patient on site. Medical

treatments may include: suture small lacerations, IVs, cardiograms, even applying casts to

minor fractures.

Remote Patient Monitoring, which is a demonstration project that uses wireless

technology to monitor residents with chronic health failure or chronic obstructive

pulmonary disease remotely from the comfort of their own homes. The technology notifies

a paramedic when warning signs arise. The paramedic makes patient contact and will refer

the patient to a medical provider for treatment, before the onset of a crisis requiring

immediate medical intervention and transport. This demonstration project is being trialed



by the following Ontario paramedic services: Hastings Quinte, Peterborough, Wellington,

Cochrane, Parry Sound, Essex, Grey, Renfrew and Sudbury. The trial is funded through

Canada Health Infoway and is strongly supported by the respective LHINs.

Telehealth: Since 2001, the MOHLTC has managed a telephone‐based program whereby

citizens can remotely seek medical advice and treatment options from a designated

provider. Recently, Telehealth has been publicized more so under the provincial “make the

right call” initiative. Soon ‐ if enabled by an extended scope of practice for paramedics,

emerging CACC technology and structured physician oversite ‐ we may see paramedics

participating in Telehealth initiatives.

14.2 OCPS’ Community Paramedicine Experience

OCPS participates in a CREMS Community Paramedicine program, working collaboratively with

the following agencies and others, to connect patients (particularly seniors and persons with

chronic conditions) with ongoing care support from an appropriate health care or social service

agency within the community: Community Care Access Centre (CCAC), Canadian Mental Health

Association, Oxford County Public Health, the Woodstock and Area Community Health Centre,

and the Alzheimer Society.

Such patients are high‐volume EMS users who otherwise, would call 9‐1‐1 frequently for

ambulance services.

CREMS effectiveness statistics for OCPS are not readily available. However, EMS peers report

30% to 50% reductions in ambulance transports for this sector of the population. In our opinion

the Oxford County experience is likely to be similar.

Recommendations:

We recommend that OCPS consider expanding its participation in Community Paramedicine

beyond the current CREMS program; potentially to include some of the other programs listed

above, as means for sustaining service excellence, while also curbing its future EMS resourcing

needs, and corresponding cost escalations.

Previously in Section 3.11, we recommended that OCPS should recruit a Performance Analyst

whose responsibilities will be to assemble and assess EMS operations‐related statistical data

that will be used to improve the services.

We recommend that this incumbent should also be responsible to establish and track Key

Performance Indicators (KPI) pertaining to OCPS’ participation in the CREMS Community

Paramedicine program; and to investigate additional Community Paramedicine programs for

Oxford County.

14.3 Falls Prevention as a Key Strategy for CREMS

In 2016, twenty (20) Oxford County addresses accounted for almost 2,000 OCPS ambulance

responses. This volume represents about 18% of all Priority 1‐4 ambulance responses, in 2016.



With OCPS’ assistance, we examined the ambulance call reports for a sample of three locations.

All three locations are situated in Woodstock, and they represent a mix of independent living,

senior’s assisted living, and long‐term care. Our findings are as below.

The three locations generated a combined total of 715 calls for ambulance assistance; and 168

of these calls (23%) involved a person whose injury was attributed to suffering a fall.

This finding is somewhat surprising, since ‘falls prevention for seniors’ is a LHIN priority

strategy, intended to alleviate an unnecessary burden from off the health care system.

Moreover, falls prevention programs by other jurisdictions have reported reductions in falls by

seniors, of 20% or more.

The above noted findings are for a sample of 3 Oxford County locations, out of 20 locations

that collectively generated 2,000 ambulance responses in 2016. If we assume a similar call

profile for all 20 locations, then by extrapolation, persons suffering a fall would account for 460

ambulance responses that OCPS completed in 2016 (i.e., 23% of 2,000).

If a falls prevention program targeting these locations had been in place in 2016, with capability

to reduce falls by seniors by 20%, then falls by seniors would have been reduced by about 92

ambulance responses that year (20% of 460).

From 2015 to 2016, OCPS’ workload increased by 1,770 Priority 1‐4 ambulance responses. If a

falls prevention program targeting these locations had been in place in 2016, then according to

the above figures, OCPS’ workload increase 2015 to 2016, would have been curbed by 5% (i.e.,

92 divided by 1770), with an estimated savings of about $40,000 in ambulance coverage. 18

This is the estimated annual saving for 20 County locations. The estimate does not account for

other County‐based senior’s facilities. Nor does it account for seniors residing at home. The

actual financial savings County‐wide, can be significantly larger – but this needs to be affirmed

by OCPS, who would require assistance from others, including the LHIN and local hospitals.

Recommendation: While OCPS’ participation in CREMS has reduced ambulance transports, the

potential exists to decrease the numbers further. Research confirms that a large proportion of

CREMS referrals involve seniors whose injuries are due to suffering a fall. For this reason, we

recommend that OCPS should promote ‘falls prevention for seniors’ as a priority strategy for

the County’s CREMS program.

18 The underlying assumptions include: time-on-task of 1 hour per call; marginal cost of $157 an hour to staff an ambulance; and target UHU of 35%.



APPENDIX A: LIST OF ACRONYMS


APEXPRO CONSULTING INC. A ‐ 1

APPENDIX A: LIST OF ACRONYMS

ACP Advanced Care Paramedic

ACR Ambulance Call Report (this term is used interchangeably with PCR)

ADRS Ambulance Dispatch Reporting System

AMO Association of Municipalities of Ontario

AMPDS Advanced Medical Priority Dispatch System

ASR Ambulance Service Review

BEC Balanced Emergency Coverage

CACC Central Ambulance Communications Centre

CAD Computer Aided Dispatch

CAO Chief Administrative Officer

CCAC Community Care Access Centre

CME Continuous Medical Education

CODE CRITICAL 3 or fewer ambulances are available to respond to the next call

CODE ZERO No ambulances are available / they all are tied up on calls (also referred to as CODE CAPACITY)

CTAS Canadian Triage Acuity Scale

CVA Cerebrovascular Accident (Stroke)

DDA Designated Delivery Agent

DPCI2 Dispatch Priority Card System V2.0

e‐ACR Electronic Ambulance Call Report (this term is used interchangeably with ePCR)

ED Emergency Department (also referred to as Emergency Room)

EFRT Emergency First Response Team (typically operated by a volunteer fire department)

EMS Emergency Medical Services (this term is used interchangeably with the terms ‘ambulance’ and ‘paramedic services’)

EOC Emergency Operations Centre

e‐PCR Electronic Patient Care Report (this term is used interchangeably with e‐ACR)

ERU Emergency Response Unit staffed with 1 paramedic (this term is used interchangeably with PRU)

ERV Emergency Response Vehicle (typically operated by a Platoon Superintendent / Also referred to as a command vehicle)

ESU Emergency Support Unit

FIR Financial Information Return

FTE Full time equivalent


APEXPRO CONSULTING INC. A ‐ 2

HR Human Resources

HRI Human Resource Information

IT Information Technology

JBS Jacob Business Systems

KPI Key Performance Indicators

LHSC London Health Sciences Centre

LHIN Local Health Integration Network

MBNCanada Municipal Benchmarking Network Canada (formerly known as OMBI)

MOF Ministry of Finance

MOL Ministry of Labour

MOHLTC Ministry of Health and Long‐Term Care

NFPA National Fire Protection Association

OAPC Ontario Association of Paramedic Chiefs

OCPS Oxford County Paramedic Service

OHS Occupational Health and Safety

PAD Public Access Defibrillation

PCP Primary Care Paramedic

PCR Patient Care Report (this term is used interchangeably with ACR)

PRU Paramedic Response Unit staffed with 1 paramedic (this term is used interchangeably with ERU)

PTSD Post‐Traumatic Stress Disorder

QA Quality Assurance

RERU Rural Emergency Response Unit

RTPP Response Time Performance Plan

SWORBHP Southwest Ontario Regional Base Hospital Program based in London

UTM Upper Tier Municipality

UU Unit Utilization

VSA Vital Signs Absent

WKDY Weekday

WSIB Workplace Safety and Insurance Board



APPENDIX B: PCP / ACP COMPETENCIES


APEXPRO CONSULTING INC. B ‐ 1

APPENDIX B: PCP / ACP COMPETENCIES

PRIMARY CARE PARAMEDIC (PCP) ADVANCED CARE PARAMEDIC (ACP)

ACADEMIC TRAINING 2‐YEAR COLLEGE PROGRAM (LICENSURE) 3‐YEAR COLLEGE PROGRAM (LICENSURE)

PARAMEDICAL SERVICE DELIVERY CAPABILITY

• Rooted in formal education and training, including instruction in symptom relief and controlled/delegated medical acts

• Measured in terms of knowledge, problem‐solving and decision‐making

• Added knowledge and skills for more advanced assessment, treatment and management of life‐threatening problems

ASSESSMENT / DIAGNOSTICS

• Triage and manage a multiple‐patient incident • Take patient history / conduct assessment including cardiovascular,

neurological, respiratory, gastrointestinal, psychiatric and bariatric • Assess vital signs / perform diagnostic tests including sepsis, stroke and

heart attack • Perform 12 lead ECG and identify S‐T Elevation Myocardial Infarction

(STEMI) cardiac patients

All PCP skills PLUS • More advanced assessment and treatment for toxicological syndromes and

neonatal patients • More advanced cardiac and ECG assessment, including 15 lead ECG and

ability to identify complex cardiac dysrhythmias

AIRWAY MANAGEMENT / VENTILATION

• Placement of Oro and Nasopharyngeal airways and King LT Supraglottic airway

• Use of Continuous Positive Airway Pressure (CPAP) on patients with severe respiratory difficulty

All PCP skills PLUS • Advanced Airway placement via Nasal or Oral Endotracheal intubation • Foreign body airway blockage removal via laryngoscope and McGill Forceps

RESPIRATORY SUPPORT

• Administer oxygen using portable delivery system • Ventilation using manual (mechanical) positive pressure device

All PCP skills

CARDIAC • Cardiopulmonary Resuscitation (CPR) • Automated external defibrillation (AED) • Manual defibrillation • PCP‐IV, IV fluid

All PCP skills PLUS • IV therapy with medications • Cardioversion and other advanced cardiac pacing

TRAUMA INJURIES • Dressing, bandaging and immobilization procedures for soft tissue injuries including burns, eyes, penetration wounds, and local cold injuries

• Immobilize and treat suspected fractures • Traction splint for femurs • Application of Kendrick Extrication Device (KED) • Taser probe removal

All PCP skills PLUS • Needle Chest Decompression (Needle Thoracotomy) for Tension

Pneumothorax

MEDICATION ADMINISTRATION

Carries medication to treat: • Diabetic emergencies • Narcotic overdose reversal • Nausea and vomiting • Allergic reactions

• Acute respiratory • Minor pain medication (Tylenol

and Acetaminophen)

All PCP medications PLUS • ACLS cardiac medications • Post cardiac arrest • Sepsis B/P support (Dopamine) • Pain medication (morphine)

• Cardiac dysrhythmia

management medications • Seizures • Chemical sedation

Principal Source: National Occupational Competency Profile for Paramedics, by Paramedic Association of Canada, 2011



APPENDIX C: EMERGENCY RESPONDER TRAINING


APEXPRO CONSULTING INC. C ‐ 1

APPENDIX C: EMERGENCY RESPONDER TRAINING

(GENERAL ILLUSTRATION)

FIREFIGHTER (EMERGENCY RESPONDER) EMERGENCY MEDICAL RESPONDER COMBINED PCP/ACP AMBULANCE CREW

IN SERVICE TRAINING 8‐40 HOURS

RECOGNIZED TRAINING PROGRAM 80‐120 HOURS

COLLEGE PROGRAM (LICENSURE) PCP ‐ 2 YEARS / ACP ‐ 3 YEARS

• Periodic updates (8‐20 hours) • Recertification 40‐44 hrs every 3 years • Structured CQI / Rigorous QA • Annual recertification (Base Hospital)

• Basic airway management • Basic airway management • More advanced airway management including CPAP

• Intubation & foreign blockage removal (ACP)

• Administer oxygen • Administer oxygen • Administer oxygen • Manual respiratory support

• CPR / AED • CPR / AED • CPR / AED • Manual defibrillation / IV starts • Cardioversion and other advanced cardiac pacing

(ACP)

• Scene assessment, rapid body survey • Standard first aid, basic wound management,

C‐spine immobilization

• Basic triage and assessment of multiple patients • Advanced first aid, dressing, bandaging and

immobilization

• Advanced triage, assessment & diagnostic testing • 12‐lead ECG / 15 lead (ACP) • Advanced problem identification and treatment,

ranging from relatively minor to complex life‐threatening

• Symptom assist • May administer Glucagon for low blood

sugar, and EpiPen (Epinephrine) • No controlled / delegated medical acts

• Trained in symptom assist • May administer Glucagon for low blood sugar,

and EpiPen (Epinephrine) • No controlled / delegated medical acts

• Trained in symptom relief and controlled / delegated medical acts

• May administer 15+ medications • Presently may not apply EpiPen



APPENDIX D – HOURLY RESPONSE PROFILES (2016)


APEXPRO CONSULT ING INC . D ‐ 1

APPENDIX D: HOURLY RESPONSE PROFILES (2016)

WOODSTOCK BASES 00 & 01



INGERSOLL BASE 02



TILLSONBURG BASE 03



RURAL BASES 04, 05 & 07



APPENDIX E – HOURLY UHU PROFILES (2016)


APEXPRO CONSULTING INC. E ‐ 1

APPENDIX E: HOURLY UHU PROFILES (2016)

OCPS

WOODSTOCK BASES 00 & 01

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

UNIT HOUR UTILIZA

TION

DAY: 07:00 ‐ 19:00 HOURS NIGHT: 19:00 ‐ 07:00 HOURS

HOURLY UHU PROFILE FOR WOODSTOCK BASES 00 & 01 (2016)

90TH PERCENTILE UHU

DAY = 33%NIGHT = 31%

24‐HOUR = 34%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

UNIT HOUR UTILIZA

TION


HOURLY UHU PROFILE FOR OCPS (2016)

90TH PERCENTILE UHU


24‐HOUR = 38%



INGERSOLL BASE 02

TILLSONBURG BASE 03

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

UNIT HOUR UTILIZA

TION


HOURLY UHU PROFILE FOR TILLSONBURG BASE 03 (2016)

90TH PERCENTILE UHU


24‐HOUR = 38%

0%

5%

10%

15%

20%

25%

30%

35%

40%

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

UNIT HOUR UTILIZA

TION


HOURLY UHU PROFILE FOR INGERSOLL BASE 02 (2016)

90TH PERCENTILE UHU


24‐HOUR = 32%



RURAL BASES 04, 05 & 07

0%

10%

20%

30%

40%

50%

60%

70%

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

UNIT HOUR UTILIZA

TION


HOURLY UHU PROFILE FOR RURAL BASES 04, 05 & 07 (2016)

90TH PERCENTILE UHU


24‐HOUR = 51%

Report No: PW 2018-06

PUBLIC WORKS Council Date: April 11, 2018

Page 1 of 5


From: Director of Public Works

Amended Blue Box Program Plan

RECOMMENDATIONS 1. That County Council receive Report PW-2018-06 titled “Amended Blue Box

Program Plan” as information;

2. And further, that a copy of this report be circulated to Area Municipalities.

REPORT HIGHLIGHTS

The purpose of this report is to provide County Council with information related to the draft

proposal to amend the Blue Box Program Plan (BBPP) as developed by the Resource Productivity and Recovery Authority (RPRA) and Stewardship Ontario.

The proposed draft BBPP sets out how the Blue Box Program will be transitioned from being funded 50/50 between municipal governments and producers to being full producer responsibility under the Waste Diversion Transition Act (WDTA).

Submission of the draft BBPP to the Minister has been delayed as more time is needed to address comments received from municipalities and the waste management industry. Should the proposed draft BBPP be approved by the Minister, staff will report back to County Council and recommend whether the County should transition to full producer responsibility or continue its current Blue Box Program under the existing 50% funding model.

Financial Impact There will be no financial impact for the budget year 2018. Currently, the projected financial impacts for future years are unknown. Any changes to the financial impacts will be reflected in future years’ budgets.



Page 2 of 5

The Treasurer has reviewed this report and agrees with the financial impact information.

Risks/Implications With the potential for the Blue Box Program to transition to full producer responsibility, there are several issues that will be of critical importance to municipalities. These include:

Maintenance of current standards of service to residents.

Availability of information to help manage contracts with service providers during the transition.

Appropriate management of any “stranded capital assets” in the waste system.

Recovery of costs required to manage materials left in municipal waste streams.

Incentives to drive continuous improvement of waste diversion programs.

Loss of municipal control of programs, customer service, and education campaigns.


1. i. A County that Works Together – Strengthen, diversify and broaden the economic/prosperity base through:

- Strategies to retain and support existing businesses and grow our green economy

3. i. A County that Thinks Ahead and Wisely Shapes the Future – Influence federal and provincial policy with implications for the County by:

- Advocating for federal and provincial initiatives that are appropriate to our county

3. iii. A County that Thinks Ahead and Wisely Shapes the Future - Demonstrated commitment to sustainability by:


o Responsible environmental leadership and stewardship



Page 3 of 5

DISCUSSION

Background Currently, the costs to operate programs for the collection and processing of Blue Box recycling paper products and packaging is split 50/50 between municipal governments and the producers of these items. Bill 151, the Waste-Free Ontario Act, 2016 was proclaimed by the Ontario Legislature on November 30, 2016. The new legislation enacted the Waste Diversion Transition Act 2016 (WDTA) and the Resource Recovery and Circular Economy Act 2016 (RRCEA) and is the first step towards full producer responsibility, making producers fully responsible for end-of-life management of designated products and materials, including but not limited to paper products and packaging. The current Blue Box Program, along with other existing waste diversion programs for Municipal Hazardous and Special Waste (MHSW), Waste Electrical and Electronic Equipment (WEEE), and Tires will be transitioned and governed through regulations to be developed under the RRCEA. Specifically, the range of recycled products collected through the Blue Box Program will be revised through this process. In December of 2017, the draft BBPP (Attachment 1) was released by Stewardship Ontario for consultation. Staff participated in several webinars/meetings and provided input to the Ontario Waste Management Association (OWMA), the Municipal Waste Association (MWA) and the Association of Municipalities of Ontario (AMO) who submitted the comments to Stewardship Ontario. Stewardship Ontario was required to review and make a concerted effort to address municipal comments received before providing the revised BBPP to the RPRA. The amended BBPP was due February 15, 2018 to the Minister for his consideration to approve, reject, or amend. As of February 15, 2018, Stewardship Ontario and the RPRA have determined that more time is needed to address comments received on the draft BBPP document. There have been no communications from either Stewardship Ontario or the RPRA on the status of the plan other than to inform municipalities that more time is required. Any potential impact of the upcoming provincial election on the finalization of the BBPP is not known at the time of this report.

Comments The scope of recycled products that the BBPP has proposed, which would be consistent across the province, will include:

Paper products.

Primary packaging.

Convenience packaging.

Transport packaging.

Ancillary packaging elements.

Packaging–like Products that are made of glass, metal, plastic and paper or a combination thereof.



Page 4 of 5

The BBPP proposes to standardize an approved list of accepted materials which can be collected to only those items that can be recycled across the province. During consultation, the approved list of accepted materials was expanded. While the majority of Blue Box items collected in Oxford County are on the approved list, there are some remaining items (i.e. toys, textbooks, pots, pans, and other non-packing items) that would no longer be collected should the BBPP be fully transitioned. However, in these cases, the BBPP proposes to add items as new reliable markets are developed over time. For the purpose of the BBPP, Ontario resident brand holders and first importers are obligated stewards and will be responsible for their products to end-life. Stewards will be required to report and pay fees on all obligated packaging and paper products (PPP). Not all PPPs will have diversion end markets, but the fees will be used to develop these end markets. Steward fees are proposed to rise in 2019 in anticipation of municipalities transitioning from the 50/50 model to 100% full producer funding. It is expected that the province will have fully transitioned communities to the full producer funding model by 2025. Stewardship Ontario has proposed to divide the province into 5 geographic transition “catchment” areas as part of the BPPP. The catchment areas have yet to be defined but it has been proposed that communities representing between 15% and 25% of Ontario households will be transitioned each year. When their catchment area is eligible, municipalities can decide if they wish to fully transition to the BPPP, defer transition until a later date, or maintain their current Blue Box Program status. As part of the transition process, Stewardship Ontario will procure collection and processing services with the cost fully funded by the Stewards under a 100% funding model. Where a community wishes to provide their own collection and processing after transition, Stewardship Ontario will use benchmarking pricing to fund programs. Funding will be dependent on the competitiveness of the municipally run programs as compared to the Stewardship Ontario procured services. Communities that choose not to transition will continue to be funded at 50% of their verified net costs from the previous two (2) years. The new BBPP has proposed a province-wide target diversion rate of 75% to be achieved two (2) years following the transition of all communities. In transitioned communities, Stewardship Ontario will be responsible for meeting the target. For communities who do not wish to transition and provide their own services, funding will be based on the ability to meet the target. Until the plan is finalized by Stewardship Ontario and approved by the RPRA and by the Minister, the transition process is on hold and the existing Blue Box Program will continue to remain equally split between municipal governments and producers. The first catchment area and opportunity to transition is expected to occur two (2) years after Ministry approval.



Page 5 of 5

Conclusions Should the draft BBPP be approved by the Minister, Oxford County staff will give detailed consideration to the plan and report back to County Council with a recommendation as to whether it would be beneficial for the County to transition to full producer responsibility, defer the transition timing, or continue its current Blue Box Program under the existing 50% funding model. As part of this potential full transition consideration, staff would meet with Stewardship Ontario to negotiate whether the County would retain contract management authority over the collection contract (such as customer service) and if the service would continue being provided through its current contractors (who would be expected to meet the benchmarking pricing). All responsibilities around the processing of recyclable materials will fall solely under the jurisdiction of Stewardship Ontario.

SIGNATURES

Report Author: Original signed by: Dave Vermeeren Supervisor of Waste Management

Departmental Approval: Original signed by: David Simpson, P.Eng., PMP Director of Public Works

Approved for submission: Original signed by:


ATTACHMENT Attachment 1: Blue Box Program Plan, Draft for Consultation, December 2017

CONSULTATION DRAFT – DECEMBER 2017

DRAFT

Attachment 1 to PW 2018-06April 11, 2018


CONTENTS 1. Glossary of Key Terms and Acronyms ................................................................................................ 1

2. Introduction ..................................................................................................................................... 4

2.1 Minister’s Request Letter ..................................................................................................................... 4

2.2 About Stewardship Ontario ................................................................................................................. 4

2.3 Objectives of an Amended Blue Box Program Plan ............................................................................. 4

2.3.1 Figure 1 ........................................................................................................................................ 6

2.3.2 Addressing the Minister’s Direction ............................................................................................ 6

2.4 Changes to this Plan ............................................................................................................................. 7

3. Consultation & Engagement.............................................................................................................. 7

4. Definition of Paper Products and Packaging....................................................................................... 7

5. Definition of Steward ....................................................................................................................... 8

5.1 Stewards for Packaging ........................................................................................................................ 8

5.2 Stewards for Paper Products ................................................................................................................ 9

5.3 Stewards for Transport Packaging and Convenience Packaging .......................................................... 9

5.4 Franchisor is Obligated for Ontario Franchisees .................................................................................. 9

5.5 Exempt Persons .................................................................................................................................... 9

5.6 CNA/OCNA Member Newspaper Fees and In-kind Contributions ....................................................... 9

6. The Status and Process for Non-Transitioned Communities .............................................................. 10

6.1 Roles and Responsibilities of Non-Transitioned Communities .......................................................... 10

6.2 Payments to Non-Transitioned Communities .................................................................................... 10

6.2.1 Calculation of Payments to Non-Transitioned Communities .................................................... 10

6.2.1.1 Figure 2 .................................................................................................................................. 11

6.2.1.2 Figure 3 .................................................................................................................................. 11

6.2.1.3 Figure 4 .................................................................................................................................. 11

6.3 Continuous Improvement Fund ......................................................................................................... 11

6.3.1 Use of Funds and Wind-Down ................................................................................................... 12

7. Transitioning Communities to Full Producer Responsibility .............................................................. 12

7.1 Transition Timeline ............................................................................................................................. 12

7.1.1 Phase A – Transition Planning: ................................................................................................... 12

7.1.2 Phase B – Community Transition: .............................................................................................. 13

7.1.2.1 Figure 5 .................................................................................................................................. 13

7.2 Timeline Assumptions ........................................................................................................................ 13

7.3 Program Funding ................................................................................................................................ 14

7.4 Program Delivery Principles ............................................................................................................... 14

7.5 Program Delivery Approach ............................................................................................................... 15

7.5.1 Procurement Frameworks ................................................................................................................. 15

DRAFT


7.5.2. Catchment Design & Sequencing ..................................................................................................... 15

7.5.2.1 Step 1: Community – Preliminary Declaration of Intention to Transition ............................. 15

7.5.2.2 Step 2: Stewardship Ontario – Development of Catchment Boundaries & Sequence .......... 16

7.5.2.3 Step 3: Community – Final Declaration of Intention to Transition ........................................ 16

7.6 Catchment Design & Sequencing ....................................................................................................... 16

7.6.1 Community – Evaluation & Preliminary Declaration of Transition Intention .................................... 16

7.6.2. Stewardship Ontario Principles & Process for Catchment Design in Preparation for Consultation 17

7.6.2.1 Guiding Criteria for Development of Catchments ................................................................. 17

7.6.2.2 Process for Defining Catchments ........................................................................................... 18

7.6.2.3 Process for Sequencing Catchments ..................................................................................... 18

7.6.2.4 Figure 6 .................................................................................................................................. 19

7.6.3. Community – Final Declaration to Transition ................................................................................... 19

7.6.4. Transition Support ............................................................................................................................ 20

7.7 Service Procurement Objectives ........................................................................................................ 20

7.8 Procurement and Payment for Collection Services ........................................................................... 20

7.8.1 Community as a Collection Tendering and Contract Management Agent for Curbside and Multi-Family Dwellings ............................................................................................................................... 21

7.8.1.1 Development of Tendering Instruments ........................................................................... 21

7.8.1.2 Procurement of Collection Services ....................................................................................... 21

7.8.1.3 Payment for Collection Services ............................................................................................ 21

7.8.2 Community Chooses not to act as a Collection Tendering and Contract Management Agent for Curbside and Multi-Family Dwellings ......................................................................................................... 22

7.8.3 Community Self-Delivers Collection and Chooses to Continue to Collect PPP on Behalf of Stewardship Ontario for Curbside and Multi-Family Dwellings ................................................................. 22

7.8.3.1 Payment for Collection Services ........................................................................................ 22

7.8.4 Collection from Residential PPP Drop-off at Depots ................................................................. 23

7.8.4.1 Payment for Depot Collection Services ...................................................................................... 23

7.8.5 Collection of PPP from Multi-Family Buildings not Serviced by Communities .......................... 23

7.8.5.1 Multi-Family Expansion Approach and Timing ...................................................................... 23

7.8.5.2 Payment for Collection Services ............................................................................................ 24

7.8.6 Collection of PPP from Public Spaces and Parks ........................................................................ 25

7.8.7 Consideration for Additional Expansion of PPP Collection Services .......................................... 25

7.8.7.1 New Communities ................................................................................................................. 25

7.8.7.2 Service Level by Community Population ............................................................................... 25

7.8.7.3 Additional Collection Channels .............................................................................................. 25

7.9 Procurement and Payment of Post-Collection Services ..................................................................... 25

7.10 Standardized List of Materials Collected ............................................................................................ 27

7.11 Communications, Promotion and Education ..................................................................................... 28

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7.12 Minimizing Stranded Assets ............................................................................................................... 29

8. Ensuring Competitive, Fair and Open Markets ................................................................................. 29

8.1 Promoting Competition and Ensuring Market Fairness ..................................................................... 30

8.2 Preventing Barriers to Competition Under Individual Producer Responsibility Regulation Under the RRCEA ……………………………………………………………………………………………………………………………………………………..31

8.2.1 Contract design .......................................................................................................................... 32

8.2.2 Assignment of Collection contracts ........................................................................................... 32

9. Dispute Resolution Process ............................................................................................................. 33

10. Program Performance..................................................................................................................... 33

10.1 Tracking Program Performance for Non-Transitioned Communities ................................................ 33

10.2 Tracking Program Performance for Transitioned Communities ........................................................ 33

10.2.1 Method for Calculating the Diversion Target ............................................................................ 34

10.2.1.1 Figure 7 .................................................................................................................................. 34

10.2.2 Timeline for Reporting the Diversion Target ............................................................................. 34

10.2.3 Timeline and Approach to Achieving a 75% Diversion Rate ...................................................... 35

10.2.3.1 Figure 8 .............................................................................................................................. 35

10.3 Material-Specific Management Targets for PPP Supplied to Transitioned Communities ................. 35

10.3.1 Material-Specific Targets ........................................................................................................... 35

10.3.1.1 Figure 9 .................................................................................................................................. 36

10.4 Other Performance Indicators ........................................................................................................... 36

11. Waste Reduction ............................................................................................................................ 37

11.1 Timeline for Waste Reduction Initiatives ........................................................................................... 39

11.1.1 Figure 10 .................................................................................................................................... 39

12. Program Financing .......................................................................................................................... 40

12.1 Figure 11 ............................................................................................................................................. 40

13. Registration, Reporting, Record Keeping and Auditing ..................................................................... 41

13.1 Registration & Reporting .................................................................................................................... 41

13.2 Record Keeping .................................................................................................................................. 41

13.3 Auditing .............................................................................................................................................. 41

Appendix A - Changes to the 2016 Municipal Datacall User Guide ......................................................... 42

Appendix B - Initial List of PPP Targeted for Collection in Transitioned Communities ............................. 46

Appendix C - Sample Terms and Conditions ......................................................................................... 47

Appendix D - Program Agreement between Stewardship Ontario and The Authority ............................. 52

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1. GLOSSARY OF KEY TERMS AND ACRONYMS

Ancillary Packaging Elements include but are not limited to labels attached to a package, brushes or measuring devices which form part of the packaging closure, staples, pins, and clips that are discarded by residential Consumers.

Authority means the Resource Productivity and Recovery Authority.

Blue Box Program Plan or Plan means the Blue Box Program Plan submitted to the Minister on February 15, 2018.

Brand Holder means a person who owns or licenses a Brand or who otherwise has rights to market a product under the Brand.

Catchment means a logical cluster of Communities that will constitute the geographic service boundaries for Post-Collection.

Census Subdivision is the general term for Communities (as determined by provincial/territorial legislation).

CNA/OCNA Members means members of the Canadian Newspaper Association or the Ontario Community Newspaper Association or members of any such successor organization.

Community or Communities means municipalities and Indigenous Communities in Ontario.

Collection is the means by which PPP is gathered from Ontario households.

Collector means either a Community providing Collection services directly or managing one or more Collection service providers on behalf of Stewardship Ontario, or a private service provider providing Collection services directly to Stewardship Ontario.

Consumer means an individual acting for personal, family or household purposes and does not include a person who is acting for business purposes.

Continuous Improvement Fund (CIF) means the fund of money set aside from past municipal payment obligations for the purpose of supporting Communities in their efforts to increase program effectiveness and efficiency.

Convenience Packaging means material used in addition to Primary Packaging to facilitate residential Consumers’ handling or transportation of one or more products, such as boxes and bags filled at point of sale.

Datacall means the detailed survey operated, maintained and verified by the Authority of participating Non-Transitioned Communities that operate PPP recycling programs.

Data Year means the year for which the Steward is reporting, which could be:

(a) calendar year in which the Steward Supplied Designated Blue Box Waste; or (b) the Steward’s fiscal year in which the Steward Supplied Designated Blue Box Waste; or (c) for new Stewards only, an estimate of the Steward’s Supplied quantity of Designated Blue Box

Waste for the calendar year or fiscal year.

Designated Blue Box Waste is Paper Products or Packaging that is Supplied to a Consumer.

Diversion End-Market means a location at which the material or part of the material is:

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reused,

used in the making of new products, packaging or other activities in end-markets, or

used as a nutrient for improving the quality of soil, agriculture or landscaping.

Excluded Paper Products means bound hard and soft cover books, such as reference books, literary books and text books and paper products intended for human hygiene such as paper towels, toilet paper, facial tissue, wipes and sanitary products.

First Importer is a Person Resident in Ontario who imports Paper Products or Packaging into Ontario or is the first to take possession or control of the Paper Products or Packaging in Ontario for which a resident Brand Holder does not exist.

Franchise, Franchisor, and Franchisee have the meanings ascribed to those words in the Arthur Wishart Act and includes Franchisors who conduct business in Ontario through their Ontario Franchise System, regardless of whether the Franchisor has a Franchisor-owned fixed place of business in Ontario.

Full Producer Responsibility means financial and operational responsibility and accountability for PPP Collection and management in Ontario.

Minister means the Ontario Minister of the Environment and Climate Change.

Minister’s Request Letter means the letter from the Minister to the Chairs of the Authority and Stewardship Ontario dated August 14, 2017.

Non-PPP means any collected material that is not PPP.

Non-Targeted PPP means all PPP that is not Targeted PPP.

Non-Transitioned Communities means those Communities that have not entered into an agreement with Stewardship Ontario and Stewardship Ontario is not delivering Blue Box Collection and management services for these Communities.

Person means an individual, partnership, joint venture, sole proprietorship, corporation, government, trust, trustee, executor, administrator or any other kind of legal personal representative, unincorporated organization, association, institution, or entity.

PPP means Paper Products and Packaging Supplied to Consumers.

Packaging means:

a. Primary Packaging, b. Convenience Packaging, c. Transport Packaging d. Ancillary Packaging Elements, e. Packaging-Like Products,

that is made of glass, metal, plastic and paper or a combination thereof.

Packaging excludes:

a. Packaging Accessories, b. Storage Containers, and

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c. Packaging manufactured in whole from wood1, ceramic, crystal, rubber, leather or textile.

Packaging Accessories include items associated with Packaging that do not provide a Packaging function including but not limited to plastic cutlery, serviettes, and straws.

Packaging-Like Products means products that are indistinguishable from Packaging when discarded by residential Consumers, and includes but is not limited to aluminum pie plates, aluminum foil, plastic or paper-based beverage cups, kraft paper bags, re-sealable plastic bags, and all other Packaging-Like Products that are indistinguishable from packaging when discarded by Consumers.

Paper Products means paper made from any cellulosic fibre and includes but is not limited to paper that is either blank or contains text or other markings for copying, printing, writing and other general use, bills, booklets, brochures, calendars, catalogues, customer statements, directories, envelopes, flyers, greeting cards, wrapping paper, magazines, newspapers, receipts, corrugated cardboard boxes for moving or mailing items, tissue paper, and all other paper that is not Packaging, except for Excluded Paper Products.

Post-Collection means activities required to prepare collected materials for Diversion End-Markets, including but not limited to, consolidation, transfer, Processing and marketing of materials.

Primary Packaging means material that is used for the containment, protection, handling, delivery and presentation of a product that is provided to a Consumer at the point of sale, and includes Packaging designed to group one or more products for the purposes of sale, but does not include Convenience Packaging or Transport Packaging.

Processing means manual or mechanical sorting and quality control of PPP for the purpose of shipping to recycling Diversion End-Markets.

Promotion and Education means initiatives and activities designed to engage and encourage Consumers to make informed and proper decisions concerning the preparation and management of PPP for Collection and recycling.

Resident in Ontario means, with respect to a Person, a Person that has a permanent establishment in Ontario. In the case of Franchisors, it includes Franchisors who conduct business in Ontario through their Ontario Franchise System, regardless of whether the Franchisor has a Franchisor-owned fixed place of business in Ontario.

RPRA means Resource Productivity and Recovery Authority, and is referenced in this Plan as the Authority.

RRCEA means Resource Recovery and Circular Economy Act, 2016.

Steward means the Person who is obligated with respect to Designated Blue Box Waste.

Storage Containers means Primary Packaging intended as long-term storage for the product, including but not limited to CD or DVD cases, power tool cases and for storage of all or portions of the product.

Supplied means sold, leased, donated, disposed of, used, transferred the possession of or title of, or otherwise made available to a Consumer in Ontario or distributed for use by a Consumer in Ontario.

1 This exclusion does not include paper-based Packaging.

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Targeted PPP means PPP referenced in Appendix B under the column labelled “Included” as amended from time to time.

Transitioned Community means a Community that has entered into an agreement with Stewardship Ontario wherein Stewardship Ontario is delivering PPP Collection and management services.

Transport Packaging means material used in addition to Primary Packaging to facilitate the handling or transportation of one or more products by persons other than Consumers and which are discarded by Consumers, such as delivery envelopes or boxes or other such packaging, but does not include shipping containers designed for transporting things by road, ship, rail or air or any packaging used for the business to business (B2B) delivery of goods and not Supplied to Consumers.

Verified Eligible Net Cost means the net cost for each Non-Transitioned Community as determined by the Authority.

WDTA means Waste Diversion Transition Act, 2016.

2. INTRODUCTION

2.1 Minister’s Request Letter

This Plan responds to the August 14, 2017 Minister’s Request Letter2 to the Authority and Stewardship Ontario to develop a proposal to amend the Blue Box Program Plan.

The proposal, as detailed in this Plan, sets out the first phase of transition for the Blue Box Program to Full Producer Responsibility under the WDTA thereby setting the stage for a second phase of transition that will result in individual producer responsibility under the RRCEA.

2.2 About Stewardship Ontario

Stewardship Ontario is a not-for-profit, industry-funded organization established under the Waste Diversion Act, 2002, and continued under the WDTA. Stewardship Ontario’s mandate is to operate the waste diversion program for which it is designated which, in the case of this Plan, is for PPP. Stewardship Ontario’s Board of Directors is elected in accordance with Ontario Regulation 388/16. The Board membership is available on Stewardship Ontario’s website. For more about Stewardship Ontario, please visit www.stewardshipontario.ca.

2.3 Objectives of an Amended Blue Box Program Plan

The Minister’s Request Letter requires that the Plan:

Preserve the integrity of residential recycling while improving environmental outcomes;

Effect a seamless transition to Full Producer Responsibility resulting in uninterrupted Collection service to Ontarians;

Avoid disruption of existing Communities’ contracts and ensure an open and competitive market;

2 The Minister’s request to Stewardship Ontario and the Resource Productivity and Recovery Authority is provided pursuant to S. 13 of the WDTA.

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Minimize disruption to Communities’ capital assets; and

Provide for continuous improvement of environmental outcomes.

This Plan outlines the first phase of transition for the management of PPP from shared responsibility to an eventual regulatory policy framework of individual producer responsibility under the RRCEA. Specifically, this Plan sets out the process by which Stewardship Ontario will assume both financial and operational responsibility, as well as accountability, for PPP Collection and management in Ontario, or Full Producer Responsibility, as it is known.

Specifically, this Plan outlines an approach to smoothly transfer the responsibility for the Collection and management of PPP from Communities to Stewardship Ontario, including the consolidation, transfer, Processing and marketing of collected materials to Diversion End-Markets.

At the time of writing (2017), over 90% of all PPP, by weight, collected and managed in Ontario is done by private sector service providers operating under approximately 400 commercial agreements with individual Communities.

At its essence, the transition of PPP Collection and management to Full Producer Responsibility involves the systematic and systemic replacement of these 400 commercial agreements between Communities and private service providers with those between Stewardship Ontario and private sector service providers, as well as between Stewardship Ontario and Communities where those Communities wish to act on behalf of Stewardship Ontario for the procurement and contract oversight of PPP Collection services or to contract with Stewardship Ontario to deliver the Collection services directly.

Given that this transition is essentially about the replacement of existing contracts with new commercial relationships, the Minister’s direction to undertake the transition in a manner that supports cooperation between Stewards, Communities and the waste management industry, as well as his direction to promote competition by ensuring a fair and open marketplace have been the key imperatives in the development of this Plan. Therefore, this Plan is drafted as a business plan – focused on the means by which Stewardship Ontario will establish new commercial relationships.

As shown in Figure 1 below, following a two-year transition planning phase, Stewardship Ontario will enter into Collection and management agreements with Communities and service providers within a five-year period of the transition of the first Community. In assuming this responsibility Stewardship Ontario will seek to divert 75% of the PPP Supplied by Stewards to Consumers, as discussed in Section 10.2.

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2.3.1 Figure 1

2018 2019 2020 2021 2022 2023 2024 2025

Phase A – Transition Planning

Phase B - Community Transition

Prepare for Transition – Implement Catchments

Catchment Transition

Phase C - Program Improvement

Collection Channel Expansion

Waste Reduction (e.g. Collected Material List Expansion)

2.3.2 Addressing the Minister’s Direction

This Plan addresses all of the terms of the Minister’s Request Letter as well as issues raised during the stakeholder and Indigenous Peoples engagement and consultation process. They can be summarized as follows:

No disruption to services. There must be an orderly dissolution of existing contractual arrangements between Communities and their service providers and a seamless process by which Stewardship Ontario establishes its own contractual arrangements sufficient to meet its obligations under this Plan;

The use of competitive procurement processes by Stewardship Ontario and the Communities with whom it contracts for the procurement of PPP Collection services;

Stewardship Ontario must adequately prepare for each occurrence of Community transition and make suitable commercial arrangements for the Collection and Post-Collection management of PPP which will include expanding and harmonizing the list of materials in the existing Blue Box Program that are accepted from Ontario Consumers;

Provide private sector service providers with the opportunity to anticipate the expiry or termination of contracts held by Communities and to respond to Stewardship Ontario’s requirements for the Collection (directly to Stewardship Ontario or via a Community under contact to Stewardship Ontario) and Post-Collection consolidation, transfer, Processing and marketing of collected materials;

Provide adequate lead-time for private sector operators to facilitate their participation in Collection and Post-Collection tenders thus promoting competition by ensuring a fair and open marketplace for Blue Box services under the WDTA;

Provide a reasonable planning window for all parties in order to facilitate, cooperation among parties, including Stewards, Communities, waste management industry, and other affected parties, to bring complementary abilities to deliver better results;

Enable the development of the Post-Collection system in a manner that optimizes the consolidation, transfer, Processing and marketing of PPP. Specifically, that it will:

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o Maximize efficiency as result of increasing Post-Collection scale while minimizing transportation and handling which by extension minimizes cost, energy use and attendant greenhouse gases; and

o Increase the quantity and improve the quality of materials marketed thus maximizing commodity financial returns and minimizing residual materials requiring disposal; and

Provide sufficient time for Stewardship Ontario to establish the necessary communications and issues management capacity to engage with Consumers in the case where a Community chooses not to oversee the Collection of PPP on behalf of Stewardship Ontario.

2.4 Changes to this Plan

Changes to this Plan may be made in accordance with Section 5 of the Program Agreement, found in Appendix D.

3. CONSULTATION & ENGAGEMENT

The Authority and Stewardship Ontario jointly developed a Stakeholder and Indigenous Peoples Engagement and Communications Plan, which laid out a roadmap to ensure meaningful consultation and communications with representatives of Stewards, Communities, the waste management industry and other affected stakeholders. A copy of the Stakeholder and Indigenous Peoples Engagement and Communications Plan is posted on Stewardship Ontario’s website. A Consultation Report outlining how Stewardship Ontario and the Authority met the consultation and engagement requirements under the WDTA, as required by the Minister, will be available on Stewardship Ontario’s website.

4. DEFINITION OF PAPER PRODUCTS AND PACKAGING

Ontario Regulation 386/16 under the WDTA defines Blue Box Wastes in the following manner:

Waste that consists of any of the following materials, or any combination of them, is prescribed as Blue Box waste for the purpose of the Act:

1. Glass;

2. Metal;

3. Paper;

4. Plastic; and

5. Textiles.

This definition is broad in scope and encompasses PPP materials as well as a wide range of Consumer products. This Blue Box Program Plan applies only to Paper Products and Packaging material Supplied to Consumers, and does not include textiles.

In response to the Minister’s Request Letter, this Plan includes Packaging-Like Products and certain types of Paper Products, including for writing, copying and general use.

The definitions for Paper Products and Packaging are found in the Glossary in Section 1. These definitions provide general inclusions and exclusions and will form part of the initial Rules for Stewards established under Section 33 of the WDTA. Any changes to these definitions, inclusions and exclusions will be subject to stakeholder consultation and approval by the Stewardship Ontario and the Authority’s Boards of Directors.

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Where necessary, to assist Stewards in assessing their obligations and completing their reports, Stewardship Ontario will provide clarifications to the inclusions and exclusions using Rules for Stewards interpretive memoranda, and Steward reporting guidance.

Products that fulfill a function similar to Primary, Convenience and Transport Packaging are included in the Plan as Packaging-Like Products. These materials are nearly identical and therefore indistinguishable from Primary, Convenience and Transport Packaging, but they have not previously been subject to fees since they were not covered by the 2003 Blue Box Program Plan. As such, they are currently being managed by Communities in their Blue Box programs and have a cost associated with their end-of-life management within this system that has been allocated to materials that are subject to fees.

To continue to improve the allocation of costs to reflect the actual cost to manage a given material within the system, these materials are being added to address this issue and ensure that all producers whose materials are handled in the Blue Box are paying their fair share of costs.

To determine which products should be added, two criteria were considered. These are:

How similar is the product to a currently obligated material? The more similar a product is to an obligated item, the more likely it is to be included.

How did the producer intend the product to be used by Consumers? If the product has a function similar to Packaging and is intended to have a relatively short lifespan, it is more likely to be included.

The definition of Packaging-Like Products provides examples of products that now will be included. However, it is not intended to be definitive or comprehensive. Stewardship Ontario will make decisions regarding specific inclusions and exclusions that may arise in the context of operating the Plan and will provide direction to affected Stewards using the Rules for Stewards.

5. DEFINITION OF STEWARD

The Minister directed Stewardship Ontario to define obligated Stewards. The following definitions provide general inclusions and exclusions and will form part of the initial Rules for Stewards established under Section 33 of the WDTA. Any changes to these definitions, inclusions and exclusions will be subject to stakeholder consultation and approval by the Stewardship Ontario and the Authority’s Boards of Directors pursuant to Section 2.4 of this Plan.

Where necessary to assist Stewards in assessing their obligations and completing their reports, Stewardship Ontario will provide clarifications to the inclusions and exclusions using Rules for Stewards, Interpretive Memoranda, and Steward reporting guidance.

For Sections 5.1 and 5.2, the following definitions of “Steward” shall apply, in the order in which they are set out. If two or more Persons are obligated in Sections 5.1 or 5.2, the earlier provision shall apply. Stewards of Transport Packaging and Convenience Packaging are addressed separately in Section 5.3. Franchisors are addressed separately in Section 5.4.

5.1 Stewards for Packaging

For Packaging, the Steward is the Person Resident in Ontario who:

a. is the Brand Holder for the Ontario market; or

b. if the Person described in paragraph (a) does not exist, then a Person who manufactures, packs or fills or causes the manufacturing, packing or filling of products; or

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c. if a Person described in paragraphs (a) or (b) does not exist, then the First Importer, unless the First Importer is a Consumer.

5.2 Stewards for Paper Products

For Paper Products, the Steward is the Person Resident in Ontario who:

a. is the Brand Holder for the Ontario market; or

b. if the Person described in paragraph (a) does not exist, then a Person who manufactures or causes the manufacturing of the Paper Products; or

c. if a Person described in paragraphs (a) or (b) does not exist, then the First Importer, unless the First Importer is a Consumer.

5.3 Stewards for Transport Packaging and Convenience Packaging

Any Person Resident in Ontario that supplies Transport Packaging or Convenience Packaging to a Consumer in Ontario at point-of-sale shall be the Steward for such Transport Packaging or Convenience Packaging.

5.4 Franchisor is Obligated for Ontario Franchisees

A Franchisor is designated as a Steward with respect to all Paper Products and Packaging which are Supplied to Consumers within the Franchisor’s Ontario Franchise System.

5.5 Exempt Persons3

a. A Steward is exempt from filing and paying fees to Stewardship Ontario if, during the Data Year, the Steward’s, its Affiliates’, and/or its Franchisees’ combined Gross Revenues from all:

i. products; and/or

ii. services

Supplied in Ontario was less than $2 million.

b. Other than a Steward with Gross Revenues of less than $2 million, a Steward shall file an Annual Steward Report but shall be exempt from paying Stewardship Fees otherwise due and payable to Stewardship Ontario if, during the Data Year, the Steward, its Affiliates and Franchisees in the combined aggregate Supplied less than 15,000 kg of Designated Blue Box Waste in Ontario.

5.6 CNA/OCNA Member Newspaper Fees and In-kind Contributions

The portion of fees payable by CNA/OCNA Members that is attributable to payments to Non-Transitioned Communities, and for supply chain and Promotion and Education costs for Transitioned Communities, will be in the form of in-kind advertising. The remaining portion of fees payable by CNA/OCNA Members under Section 33(5) of the WDTA will be paid to Stewardship Ontario in cash. The portion of fees paid in the form of in-kind advertising and the portion paid in cash will be calculated using the approved fee setting methodology.

The allocation of the in-kind contribution to CNA/OCNA Members, and the permitted use of the in-kind advertising is governed by an in-kind advertising program guide. Stewardship Ontario will review and

3 The same de minimis threshold exemptions in the previous Blue Box Program Plan (2003) and associated Rules (2003 to 2018) have been carried forward into this Plan.

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update the guide each year in consultation with representatives of CNA/OCNA Members and Non-Transitioned Communities.

The portion of in-kind advertising allocated to Non-Transitioned Communities and to Stewardship Ontario for Transitioned Communities will be calculated on a relative basis of households serviced where serviced households in Transitioned Communities will receive twice the weighting as services households in the Non-Transitioned Communities.

6. THE STATUS AND PROCESS FOR NON-TRANSITIONED COMMUNITIES

This section specifies the means by which Non-Transitioned Communities will receive payments pursuant to Section 11 of the WDTA. The payments will be based on each Community’s Verified Eligible Net Cost of operating its existing Blue Box Program and will reflect each Community’s report submitted to the Authority under the reporting protocols for eligible and ineligible sources, costs and revenues as defined in the Datacall User Guide 2016 and as amended to include the list of eligible and ineligible costs and revenues listed in Appendix A.

6.1 Roles and Responsibilities of Non-Transitioned Communities

Stewardship Ontario will make payments to Communities in accordance with Section 6.2 below.

Non-Transitioned Communities will:

Operate residential recycling programs in accordance with the requirements of Ontario Regulation 101/94 and any other applicable regulations;

Engage in Consumer education and awareness activities to promote the Collection of PPP;

Provide accurate diversion and cost reports via the Authority’s Datacall in accordance with the Guide, and comply with all requirements therein (e.g. verification and audit); and

Provide access to data and facilities in order for Stewardship Ontario to discharge its obligations.

6.2 Payments to Non-Transitioned Communities

Stewardship Ontario will provide payments to Non-Transitioned Communities based on the Verified Eligible Net Costs as reported through the Authority’s Datacall.

Payments to Non-Transitioned Communities will be calculated in a manner that results in the total amount paid to each Non-Transitioned Community being equal to 50% of the total Verified Eligible Net Costs it incurred to collect and manage PPP as a result of the Blue Box Program, the manner consistent with the requirements of Section 11 of the WDTA, as detailed below.

6.2.1 Calculation of Payments to Non-Transitioned Communities

For the purpose of this section, the following terms are defined in Appendix A.

Operating Costs

Promotion and Education Costs

Capital Costs

Calculated Administration Costs

Gross Revenue

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Verified Eligible Net Costs for each participating Community are calculated as the verified sum of Operating Costs plus Promotion and Education Costs plus Capital Costs plus Administration Costs less the three year rolling average Gross Revenue.

6.2.1.1 Figure 2

The annual payment for each Community is calculated as 50% of its Verified Eligible Net Costs incurred two years prior to the reporting year (the “Payment”), as shown in Figure 3. For example, Verified Eligible Net Costs incurred in 2017 are reported by the Non-Transitioned Community and serves as proxy to calculate the Payment to a Non-Transitioned Community in 2019.

6.2.1.2 Figure 3

A majority of the Payment to each Non-Transitioned Community will be in the form of cash, with the balance being in the form of advertising space provided by CNA/OCNA Members through their in-kind fee payments.

The value of the in-kind payment provided to each Community will be calculated as the portion of in-kind fees attributable to Non-Transitioned Communities, as described in Section 5.6, prorated amongst all Communities on a relative basis using their Verified Eligible Net Costs.

Cash payments to Non-Transitioned Communities will be calculated as the Payment minus the in-kind payment and will be made in equal quarterly installments, in accordance with the schedule in Figure 4.

6.2.1.3 Figure 4

Payment Quarter Payment Issued Data

Q1 June 30

Q2 September 30

Q3 December 31

Q4 March 31

6.3 Continuous Improvement Fund

The CIF is a fund of money set aside from past Community payment obligations for the purpose of supporting Communities in their efforts to increase program effectiveness and efficiency. Stewardship Ontario administers the money held by the CIF in a segregated trust account. A CIF Committee will focus

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its work on closing down existing projects (no new capital grants), maintaining the support resources established, and providing transition support to Non-Transitioned Communities.

The CIF Committee, as overseen by the Authority, will:

Have a composition and governance structure as determined by the Authority;

Develop an annual operating plan and budget for approval by the Authority;

Administer the approved operating plan; and

Report annually to the Authority.

6.3.1 Use of Funds and Wind-Down

The CIF will wind-down no later than the transition eligibility date for the last Community to transition to Full Producer Responsibility. Funds may be used for the following purposes:

o To fund the initiatives included in the annual CIF operating plan;

o To fund existing approved project grants; and

o To fund applications by associations representing Communities (e.g. Association of Municipalities of Ontario, Regional Public Works Commissioners of Ontario, Municipal Waste Association, etc.) for additional Blue Box transition support approved by the Authority.

Upon wind-down of the CIF, any remaining balance of the funds will be disbursed to all Communities based on the proportionate share of each Community’s Payment as a percentage of Payments to all Communities in the last full calendar year before any Communities transition to Full Producer Responsibility.

7. TRANSITIONING COMMUNITIES TO FULL PRODUCER RESPONSIBILITY

This section sets out the timelines, costing, principles, mechanisms and means by which Stewardship Ontario will transition Communities to Full Producer Responsibility.

7.1 Transition Timeline

The transition to Full Producer Responsibility is comprised of two phases:

7.1.1 Phase A - Transition Planning:

Stewardship Ontario will, in consultation with Communities and the waste management industry, define the Catchments, which are geographic service boundaries for aggregating, Processing and marketing collected PPP.

Stewardship Ontario will seek feedback from Communities on the design of supply chain commercial agreements such as Statements of Work (SOW), Master Services Agreements (MSA) and pro-forma PPP Collection contracts.

Stewardship Ontario will canvass Communities on whether they wish to transition, how they will manage their existing contracts and assets upon transition, and if they wish to deliver Collection contract management services upon transition or directly deliver Collection services.

Stewardship Ontario will sequence the transition of Catchments using data provided by Communities.

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The first wave of competitive procurement processes for Collection and Post-Collection management will be undertaken.

7.1.2 Phase B – Community Transition:

Communities will be eligible to transition to Full Producer Responsibility based on the sequencing of Catchments developed during Phase A – Transition Planning (See Section 7.5.2).

7.1.2.1 Figure 5

7.2 Timeline Assumptions

The following are the key timeline assumptions for the implementation of this Plan:

1. This Plan will be approved by June 1, 20184;

2. Stewardship Ontario requires two years to prepare for the first Community transition;

3. Stewardship Ontario will engage with representatives from Communities and the waste management industry in the design and review of the Catchments;

4. Stewardship Ontario will publish draft Master Services Agreements and statements of work in time for the Communities to make a declaration of intention to transition;

5. Community representatives will require up to 90 days to review the final design, prepare recommendations and seek approval for transition or non-transition from their local council;

6. Stewardship Ontario will issue the final Catchments and sequencing upon final notification of Communities’ intention to transition or to remain in the current state;

4 Approval of this Plan after June 1, 2018 will result in adjustments to this timeline.

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7. Community and waste management proponents of Post-Collection services will require 90 days to respond to the first Request(s) for Proposal;

8. Upon award of Post-Collection services the proponent will require 180 days to their network;

9. The first tranche of Communities will be eligible for transition two years following approval of this Plan (on June 1, 2020);and

10. The final tranche of Communities will be transitioned by May 31, 2025.

7.3 Program Funding

Implementation of the Plan will require Steward funding of two types of costs:

1. Transition Planning Costs: Preparation costs for assuming operational responsibility of supply chain activities including staff recruitment and training, development of supply chain contracts, design of Catchments, legal, research, system development, etc.

2. Supply Chain Management Costs: Costs related to payments to Communities under Section 11 of the WDTA, as well as costs related to the cost of Collection and Post-Collection services as Communities transition to Full Producer Responsibility, including the accumulation of prudent program reserves appropriate for a non-for-profit corporation with responsibility for operating a real-time supply chain.

Steward fees are typically calculated once per year and announced to Stewards in the fourth quarter of each calendar year in order to provide Stewards with predictability in their budgeting. Transition planning activities completed after Plan approval and before December 31, 2018 will be funded from program reserves to avoid any increases to Stewards’ fees during the 2018 fiscal year.

Beginning with the 2019 fee cycle, Stewardship Ontario will increase the annual operating budget commensurate with the projected incremental expense of Transitioned Communities, program management, and operating reserve requirements as outlined in Section 12.

7.4 Program Delivery Principles

As requested by the Minister, this Plan is designed to achieve a smooth and orderly transition and to provide for continuous improvement of environmental outcomes in a manner that does not undermine existing PPP recovery efforts. To that end, the following program delivery principles will guide Plan delivery:

Focus on outcomes, not process: Improve environmental outcomes through diversion, maximized efficiency, and minimized complexity;

Maintain or improve Ontarians’ experience with and access to residential recycling services: Consumers will continue to have access to recycling services, and the types of materials that Consumers can recycle will be standardized to reduce complexity and improve system design;

Ensure a fair and open marketplace: Open and fair competition to ensure that all qualified service providers have an equitable opportunity to compete while minimizing program operating costs, as described in Section 8;

Foster interaction, collaboration and competition to drive innovation: Innovation results from the convergence of ideas and expertise found amongst all stakeholders – producers, private, public and not-for-profit organizations – and shared in a manner that fosters collaboration and delivers mutual value; and

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Set the stage for evolution: Harness existing activities and build on their success through continuous improvement and use of economic incentives that increase Collection of PPP and improve system efficiency.

7.5 Program Delivery Approach

To assist Communities in determining whether to transition to Full Producer Responsibility, Stewardship Ontario will provide information to help Communities understand:

The procurement frameworks that set out Stewardship Ontario’s terms and conditions for its Collectors and Post-Collection partners; and

How their specific Community will be prioritized for transition including the method of aggregating Communities into Catchments and the method for prioritizing those Catchments for transition to Full Producer Responsibility.

These program delivery elements are discussed in the following sections.

7.5.1 Procurement Frameworks

Stewardship Ontario will develop and communicate a standard Master Services Agreement (MSA) outlining the terms and conditions applicable to all Collection and Post-Collection Statements of Work (SOWs). The conditions within the MSA will be consistently applied to all Communities and private waste management partners delivering services to Stewardship Ontario.

Stewardship Ontario will also develop and communicate SOWs governing the specific service delivery terms and conditions for curbside, multi-family, depot and streetscape Collection services as well as the SOW for Post-Collection services.

Providing these procurement frameworks to Communities informs their decision to transition to Full Producer Responsibility and the role they may wish to play in the program (e.g., as Collection contract managers or participants in Post-Collection management systems).

7.5.2. Catchment Design & Sequencing

Communities will be aggregated into Catchments organized as logical clusters for the purposes of competitive procurement of Post-Collection services. The process to design and sequence Catchments to enable Communities to transition requires the cooperation and participation of Communities and is iterative. The following summarizes the three steps involved in designing and sequencing Catchments.

7.5.2.1 Step 1: Community – Preliminary Declaration of Intention to Transition

With consideration of the MSA and SOWs, Communities will make a preliminary declaration of their interest to:

a. transition to Full Producer Responsibility either by: i. providing Collection services under contract to Stewardship Ontario where that

Community currently self-delivers Collection, or ii. by acting as a Collection contract manager under contract to Stewardship Ontario

or

b. to cease to participate in Collection management and in doing so, require that Stewardship Ontario deliver the Collection services to their residents;

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or

c. to remain in the current state of shared responsibility and receive payments as a Non-Transitioned Community (Section 6).

When providing Stewardship Ontario with a preliminary declaration of their intention to transition to Full Producer Responsibility under condition 1a or 1b, each Community will provide Stewardship Ontario with:

i. their desired transition effective date; and ii. the conditions under which they will transition (Section 7.6.1).

7.5.2.2 Step 2: Stewardship Ontario – Development of Catchment Boundaries & Sequence

With input from Step 1, Stewardship Ontario will consider each Community’s preference in the context of a number of Catchment design criteria that include physical geography, volumes of PPP available, existing infrastructure and proximity of that Community to other Communities who have declared their intention to transition (See Section 7.6.2). These considerations will be used to prepare preliminary Catchment boundaries and a Catchment transition sequencing proposal in preparation for discussion with Communities and the waste management industry.

After discussion, Stewardship Ontario will publish the final Catchment boundaries and sequencing as needed by Communities when seeking Council or other authorizations.

7.5.2.3 Step 3: Community – Final Declaration of Intention to Transition

Communities will provide Stewardship Ontario with their final declaration of their intention to transition after having given consideration to the impact of the sequencing on their contract conditions and any other considerations required by the Community and its Council.

Completion of these three steps will enable Stewardship Ontario to formalize the Post-Collection tenders needed to ready the first Catchment for transition.

Each of these steps is outlined in more detail in the following section.

7.6 Catchment Design & Sequencing

Diversion of PPP under Full Producer Responsibility requires building a province-wide collection and post-collection reverse supply chain that consolidates and processes PPP at a scale that will result in a high quality output of materials for delivery to end-markets.

Accordingly, to optimize the management of PPP, Stewardship Ontario will aggregate Communities into geographic Catchments. A Catchment is a logical cluster of Communities that will constitute the geographic service boundaries for aggregating, Processing and marketing collected PPP.

7.6.1 Community – Evaluation & Preliminary Declaration of Transition Intention

After having reviewed Stewardship Ontario’s MSA and SOWs, each Community will assess its existing Collection and Post-Collection contracts to determine its interest and ability to transition to Full Producer Responsibility.

To submit a preliminary declaration of intention to transition to Stewardship Ontario, Communities will need to consider the status of their contracts and choose an appropriate contract management

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approach. There are three potential contract status scenarios and contract management approaches, as follows:

Contract Status 1: The Community will no longer have its own commercial agreements for Collection and Processing of PPP on the date that it wishes to transition because either its Collection and Processing contracts are simultaneously expiring naturally or it intends to terminate its existing Collection and/or Processing contracts where such contracts are ongoing or where one contract extends beyond the natural expiry of the other.

Contract Status 2: The Community will amend its contract with its Collection service provider so that it can collect PPP on behalf of Stewardship Ontario (i.e., the Community will enter into an agreement with Stewardship Ontario whereby the Community will administer the contract with the Collection service provider). In this case, the Community’s Processing contract is either naturally expiring or the Community will terminate it on the date that it transitions.

Contract Status 3: A Community has no commercial contracts for Collection and Processing of PPP (i.e., it self-delivers those services).

Stewardship Ontario will require that each Community make a preliminary declaration of its intention to either transition or defer transition to Full Producer Responsibility. Once the Catchment sequence and timing is made available, then Communities will be able to complete the final assessments of the status of their contracts and submit their intention to transition to Stewardship Ontario.

In identifying the sequencing of Catchments, Stewardship Ontario will identify which year any given Community is eligible to transition. Only when the final Catchment sequence and timing is understood will a Community be able to formalize its intention to transition given that the sequence and timing are required to complete a final assessment of its contract status.

Communities that meet or intend to meet any of the above statuses and choose to transition, will notify Stewardship Ontario and declare the following:

Its decision to transition;

If transitioning, when it wishes to transition; and

How it proposes to achieve the necessary transition conditions.

At this stage, Communities will not yet be in a position to finalize their declaration because final contract expiration, extensions or terminations cannot be made until the transitioning Community has confirmation of when their Catchment is scheduled to be open. Only when a Catchment is open is a Community able to transition.

7.6.2. Stewardship Ontario – Principles & Process for Catchment Design in Preparation for Consultation

In defining Catchment boundaries and in sequencing the Catchments, Stewardship Ontario will follow a principled and stepwise approach.

7.6.2.1 Guiding Criteria for Development of Catchments

When developing Catchments, Stewardship Ontario will seek to ensure that:

Communities comprising Catchments are geographically contiguous;

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There are transportation arteries for the movement of materials from point of Collection through consolidation to Processing. (Processing itself may or may not be contained in any given Catchment.);

Sufficient aggregate volume is available to:

o Drive logistics scale and efficiency, thereby minimizing vehicle movements and greenhouse gases;

o Incent investments in consolidation and/or advanced sorting and Processing technologies, support effective Promotion and Education campaigns and waste reduction initiatives;

Competitive Post-Collection markets and procurement is promoted;

Existing public logistics and recycling infrastructure are identified and used to foster Post-Collection efficiency, while minimizing stranded assets and capital duplication;

There is sufficient latent Post-Collection capacity to address contingencies across Catchments; and;

Consideration is given to the proximity of communities who have declared their intention to transition to one another.

7.6.2.2 Process for Defining Catchments

The process for defining Catchments will include the following steps:

1. Stewardship Ontario will develop Catchment design criteria in discussion with private sector service providers and Communities;

2. Using the design criteria and the list of Communities with intention to transition, Stewardship Ontario will develop an initial Ontario-wide Catchment boundary and sequencing proposal;

Stewardship Ontario will rely on the Authority and Communities to provide comprehensive information such as the expected PPP quantities, collection methods, contract expiry dates and capital assets.

7.6.2.3 Process for Sequencing Catchments

Stewardship Ontario’s sequencing of catchments will be based on the notifications by Communities regarding their desired transition timing and will be driven by the following planning considerations:

1. The volume of collected PPP associated with Communities in a Catchment who have notified Stewardship Ontario of their wish to transition and whose contracts are sufficient to initiate the Post-Collection competitive procurement process for that Catchment; and

2. The timing of desired transition for the remaining Communities in the same Catchment that are not ready to immediately transition.

Catchments for which a clear picture on the status of contracts is established under Steps 1 and 2 will have transition priority because:

Post-Collection service bidders participating will have a clear picture of the anticipated growth in receipts of collected volumes of PPP from transitioning Communities which will inform logistics

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and capital planning (especially with regards to processing) necessary to design their bid proposals; and

Stewardship Ontario will be able to anticipate the number of transitioning Communities in each year across Catchments as well as the number of competitive procurements for Post-Collection services it may need to undertake in any given year across Catchments.

The opening of Catchments to enable Communities to transition will have the following characteristics:

One or more Catchments may open for transition in a specific year;

Catchments will be prioritized and sequenced such that the Catchments that open for transition each year will collectively include 15% to 25% of Ontario households (resulting in all Catchments transitioning within a five-year transition period);

The Catchments and their order and timing of transition will be made available to Communities and private sector service providers; and

A Community may not transition until its Catchment has been opened.

The following Figure 6 is a conceptual representation of the Catchment transition process.

7.6.2.4 Figure 6

7.6.3. Community – Final Declaration to Transition

Once the sequencing and timing of Catchments opening to enable transition is finalized, Communities can formalize and submit their final declaration of their intention to transition5. For example, at the time of their preliminary declaration, a Community may have declared their desire to transition in 2021 yet find that the final Catchment design and transition sequencing has determined that their Catchment is not open until 2022. In this case, the Community may need to exercise its option to extend its contract for one year or to seek assistance from Stewardship Ontario for transition support (see next section). Similarly, a Community may have made a preliminary declaration of its intention to transition in 2023 yet when presented with the information that their Catchment is open in 2021, determines it has a business case to incur a contract amendment or termination penalty to allow for an early transition.

5 Stewardship Ontario will make a template declaration of intention to transition agreement available on its website for completion by Communities.

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In both cases, the Community will need time to seek the necessary authorizations to complete these contract changes.

Communities will need to provide advance notice to Stewardship Ontario of their intention to transition. Notice periods for when the declaration of intention to transition agreements will be provided to Communities when the final Catchment design and sequencing is published.

7.6.4. Transition Support

A Community may choose not to transition when its Catchment opens because it has a Processing contract that extends beyond a Collection contract that is expiring. In this case, Stewardship Ontario will offer to provide temporary transition support to that Community by allowing that Community to issue a long-term hybrid Collection tender. A hybrid Collection tender is such that one contract will contain both a set of Collection service terms in effect in the non-transitioned state, and a different set of Collection service terms for collecting PPP on behalf of Stewardship Ontario once the Community’s Processing contract expires (with the Community administering the contract throughout).

7.7 Service Procurement Objectives

Stewardship Ontario will assume responsibility to collect and manage residential PPP by procuring and paying for Collection and Post-Collection management services.

The method of procuring and paying for services will satisfy the following objectives:

Provide adequate lead-time for the waste management industry to ensure they can participate in Collection and Post-Collection tenders, thus promoting competition by ensuring a fair and open marketplace for Blue Box services under the WDTA as requested by the Minister;

Facilitate cooperation among parties, including Stewards, Communities, waste management industry, and ether affected parties, to bring complementary abilities to deliver better results;

Ensure that the Post-Collection system evolves in such a manner as to optimize the consolidation, transfer, Processing and marketing of PPP in support of the Transition to Full Producer Responsibility. Specifically, it will:

o Maximize efficiency as a result of increasing Post-Collection scale while minimizing transportation and handling which by extension minimizes cost, energy use and attendant greenhouse gases; and

o Increase the quantity and improve the quality of materials marketed thus maximizing commodity financial returns and minimizing residual materials requiring disposal.

7.8 Procurement and Payment for Collection Services

The following sections outline the conditions under which Stewardship Ontario will procure and pay for Collection services.

When a Community transitions to Full Producer Responsibility, Stewardship Ontario will cease to make payments to that Community under the shared responsibility framework (Section 11 of the WDTA) as of the effective date of transition.

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7.8.1 Community as a Collection Tendering and Contract Management Agent for Curbside and Multi-Family Dwellings

Communities have a right of first refusal to act as Collection contract management agents on behalf of Stewardship Ontario. The role of a contract management agent involves procuring and administering Collection services from qualified Collection service providers.

7.8.1.1 Development of Tendering Instruments

In discussion with Communities individually and/or through their associations, Stewardship Ontario will develop pro forma operating, performance and reporting standards to be included in the tendering instruments (e.g., statements of work, request for proposals, etc.) for procuring Collection services from qualified Collectors.

Appendix C - provides an example of performance related Collection terms and conditions that may be included in pro forma tendering instruments of Collection services.

7.8.1.2 Procurement of Collection Services

Under agreement with Stewardship Ontario, the Community acting as a Collection agent will:

Oversee the contracted Collection service provider to ensure its adherence to the performance standards;

Engage in (itself or through its Collection service provider) an escalating series of remedial measures to engage Consumers where they place more than a set percentage by weight of Non-PPP out for Collection; and

Deliver prescribed Promotion and Education under agreement with Stewardship Ontario and ensure the Collection service provider executes any Promotion and Education-related tasks assigned to it.

The competitive procurement process administered by the Community will:

Be open, fair and adhere to best practices for competitive procurement;

Be competitive such that there is a minimum of three (3) viable responds and the tender process employs techniques to avoid non-competitive procurement practices (See Section 8);

Use Stewardship Ontario’s pro forma Request for Proposal and services agreement; and

Provide Stewardship Ontario with the opportunity to participate in the evaluation of Request for Proposal responses and the selection of the Collection service provider, including the right to review and amend provisions in the contract to ensure Stewardship Ontario’s rights and interests are protected.

7.8.1.3 Payment for Collection Services

Stewardship Ontario will make the following payments to Communities that choose to act as contract management agents on its behalf:

Payments to cover the unit prices (e.g., prices per household) to be charged to the Community by the Collection agent selected through the tender;

A per unit payment for administering the Collection contract;

A per unit payment for Promotion and Education undertaken by the Community on behalf of Stewardship Ontario; and

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Financial top ups or bonuses for exceeding benchmarks for Non-PPP and Non-Targeted PPP in collected materials.

Where a Community wishes to tender for more than one line of business concurrently (e.g. issues a tender for bundled waste Collection and disposal, PPP Collection and organics Collection and Processing), or otherwise chooses not to follow Stewardship Ontario’s procurement process and tendering instruments, Stewardship Ontario will declare a benchmark price based on the PPP Collection prices realized in other similar Communities and/or similar Communities’ historical costs. Where the bid price received is in excess of the benchmark price, Stewardship Ontario will offer to pay the benchmark price. The Community may accept or reject this offer.

Where a Community has been collecting PPP from non-residential/IC&I sources previously it may include these locations in its Collection tender. However, these sources will be reported to Stewardship Ontario, the associated PPP Collection quantities from those sources will be estimated and Stewardship Ontario will not make payments to the Community for the Collection of those quantities6.

7.8.2 Community Chooses not to act as a Collection Tendering and Contract Management Agent for Curbside and Multi-Family Dwellings

In the case where a Community chooses not to act as a Collection tendering and contract management agent and wishes to transition, Stewardship Ontario will conduct the Collection tender process using the performance standards and procurement instruments described in the previous section. Stewardship Ontario will undertake all the administrative and oversight functions in administering Collection of residential PPP in that Community.

7.8.3 Community Self-Delivers Collection and Chooses to Continue to Collect PPP on Behalf of Stewardship Ontario for Curbside and Multi-Family Dwellings

In the case where a Community self-delivers Collection and chooses to continue to collect PPP as an agent to Stewardship Ontario, Stewardship Ontario will require the Community to adhere to the same performance standards that apply to agents retained through a competitive tender as described in Section 7.8.1.2.


Stewardship Ontario will make the following payments to Communities that deliver Collection services themselves and wish to collect PPP on behalf of Stewardship Ontario as an agent:

Payments per unit (e.g., per household) to be determined by using prices realized through tenders in comparable Communities and/or the Community’s historical costs as a benchmark;

A per unit payment for administering Collections;

Payment for Promotion and Education undertaken by the Community on behalf of Stewardship Ontario; and

Financial top ups or bonuses for exceeding per household Collection quantity benchmarks and/or for accelerated reductions in percentage by weight Non-PPP in collected materials.

6 These IC&I materials will be received and managed by Stewardship Ontario’s Post-Collection service providers. Stewardship Ontario will retain all commodity revenues to offset Post-Collection costs.

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Where a Community has been previously collecting PPP from non-residential/IC&I sources it may include these locations in its Collection tender. However, these sources will be reported to Stewardship Ontario, the associated PPP Collection quantities from those sources will be estimated and Stewardship Ontario will not make payments to the Community for the Collection of that material.7

7.8.4 Collection from Residential PPP Drop-off at Depots

Stewardship Ontario will offer payments to depot Collectors, both Communities and the waste management industry that are able to comply with the Collector qualification standards to provide depot Collection services.

Depot operators will be required to adhere to performance standards that will include at a minimum the PPP to be collected, the method by which collected PPP will be prepared for pick-up for introduction into the Post-Collection management system, and the maximum allowable contamination percentage by weight.

7.8.4.1 Payment for Depot Collection Services

Payments to Communities for depot Collection will be set in such a manner as to provide them with a meaningful incentive to establish and operate depots and will be benchmarked on depots’ historic costs as reported to the Datacall. The level of payments will take into account Stewardship Ontario’s performance standards.

Where a Community accepts the offer of the financial incentive, an additional incentive will be offered to provide Promotion and Education to Consumers utilizing the Community’s PPP depots.

Where a waste management company accepts the offer of the financial incentive, Stewardship Ontario will provide Promotion and Education to Consumers utilizing the depots through its own means.

7.8.5 Collection of PPP from Multi-Family Buildings not Serviced by Communities

There are 1.41 million multi-family households in Ontario8. Communities provide Collection services to 1.1 million multi-family households9, which will be serviced by Stewardship Ontario when each Community transitions. Approximately 300,000 multi-family households are not receiving PPP Collection services from Communities, although many of these are receiving Collection services from the waste management industry. This section outlines the timelines and process by which these households, and specifically the buildings in which they reside, can participate in the Blue Box Program.

7.8.5.1 Multi-Family Expansion Approach and Timing

Stewardship Ontario will employ a financial incentive based system for encouraging the waste management industry to engage multi-family dwelling property managers to establish long-term Collection arrangements for PPP. The incentive based system recognizes that:

Multi-family buildings are owned by private corporations that are not required to provide

Stewardship Ontario or its contractors access to their facilities;

7 Ibid Ref. 6 8 Municipal Datacall. 9 Municipal Datacall.

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Multi-family buildings may lack adequate recycling infrastructure to support the Collection and

storage of PPP that cannot be readily resolved by Stewardship Ontario or its contractors absent

long-term relationships between service providers and building managers; and

Recycling contracts with buildings may have very long terms, and may be bundled with the

provision of other waste management services.

Stewardship Ontario will begin offering financial incentives to Collectors to service multi-residential buildings that are not being serviced by Communities within one year of the Community transitioning. This timing is necessary so that Stewardship Ontario can begin gathering the data required to effect the rollout of Collection services to these multi-family. The data required will include:

Number of multi-family buildings and households not currently serviced by each Community;

Number of multi-family buildings and households currently serviced by the waste management

industry;

Number of multi-family buildings with recycling infrastructure restrictions;

Quantity and type of Paper Products and Packaging materials managed at multi-family

households currently serviced by the waste management industry;

Composition and quality of material managed at multi-family households currently serviced by

the waste management industry;

Incremental material quantity available to be managed from multi-family households not

currently receiving services from Communities; and

Cost of services provided to multi-family households by the waste management industry.

Qualified Collectors will be required to adhere to performance standards, which, among other requirements, will specify the maximum threshold by percentage weight allowable of Non-PPP and Non-Targeted PPP.

Where a significant percentage of multi-family households in a Community are not being managed by the Community, Stewardship Ontario may consider alternate procurement methods, such as a Request for Proposal.


Where multi-family Consumers deliver PPP to a central storage area accessible by all Consumers of the multi-family complex and Collection occurs from this central storage area, Stewardship Ontario will offer financial incentives as set payments to Collectors that are able to comply with the Collector qualification standards (including verification that the Collector has an agreement with the building manager for gaining access to the storage area) to provide multi-family building PPP Collection services.

Payments to Collectors from multi-family buildings will be set in such a manner as to provide Collectors with a meaningful incentive to establish commercial relationships with multi-family property managers. The level of payments will take into account observed market pricing for comparable multi-family recycling services as follows:

Where a Community accepts the offer of the financial incentive, an additional incentive will be

offered to provide Promotion and Education to multi-family Consumers serviced by the

Collector; and

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Where a waste management company accepts the offer of the financial incentive, Stewardship

Ontario will provide Promotion and Education to multi-family Consumers through its own

means.

7.8.6 Collection of PPP from Public Spaces and Parks

Existing public space recycling will be continued in Communities that transition to Full Producer Responsibility where the Community acts as the Collection agent to Stewardship Ontario. Stewardship Ontario will reimburse the Community for the cost of servicing the public space Collection points included in their procurement for Collection services under Section 7.8.1.3.

Where there is no current public space recycling, or in Communities that turn over Collection services to Stewardship Ontario, public space recycling will be considered at a future date once Stewardship Ontario is satisfied that the collected PPP is of sufficient quality (i.e., not overly contaminated) that it can be effectively diverted and that it does not degrade the quality of materials collected in other channels. In particular, Stewardship Ontario will be piloting and evaluating methods to collect uncontaminated PPP from public spaces.

7.8.7 Consideration for Additional Expansion of PPP Collection Services

Stewardship Ontario will consider the expansion of Collection services over time as described below.

7.8.7.1 New Communities

Stewardship Ontario will consider expanding Collection services to new Communities over time once it is satisfied that such expansion will not negatively disrupt the transition of existing programs. Prior to onboarding a new Community, Stewardship Ontario will determine if there is the necessary infrastructure in place to service the Community, and whether the Community’s Consumers are willing to participate in the Blue Box Program and whether the Community’s size, location, existing waste management practices (e.g., disposal and PPP recycling) and proximity to Post-Collection recovery warrant expansion of Collection services.

7.8.7.2 Service Level by Community Population

Collection services will be provided in transitioned Communities as follows:

Curbside and multi-family Collection where the Census Subdivision has a population of 15,000 or more; and

Depot Collection where the Census Subdivision has a population of between 5,000 and 14,999.

7.8.7.3 Additional Collection Channels

Stewardship Ontario will assess, on an annual basis, the need to establish additional PPP Collection channels to meet the objectives of this Plan, including increasing the total amount of PPP being collected to facilitate the achievement of targets, developing lower cost Collection and management options, or to increase the quality of collected materials.

7.9 Procurement and Payment of Post-Collection Services

Post-Collection management involves receiving collected materials from Collection vehicles, picking up materials from depots, consolidation and transfer where required, handling and sorting materials, preparing materials for shipment to Diversion End-Markets or downstream processors, marketing

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materials, appropriately managing residual materials and reporting the quantities of material received and marketed and other metrics to Stewardship Ontario as required.

In preparation for Stewardship Ontario assuming responsibility for the Collection and management of PPP in a given Community, Stewardship Ontario will undertake a competitive procurement process that will provide Post-Collection service providers with the opportunity to propose comprehensive Post-Collection management solutions for the collected quantities of PPP.

The competitive procurement process for Post-Collection service is a means to coordinate Post-Collection activities across Community boundaries within a Catchment to build scale efficiencies in handling, Processing and marketing of PPP and to minimize logistic inefficiency (i.e. unnecessary duplication of vehicle movements and handling).

Accordingly, Stewardship Ontario will engage PPP Post-Collection service providers, both the waste management industry and Communities, on a contractual basis using the following process:

1. Stewardship Ontario will issue a Request for Expressions of Interest (REOI) to PPP Post-Collection service providers to gauge their capacity to receive, process and market a defined list of PPP received from Collectors;

2. Stewardship Ontario will develop the procurement instruments (e.g. tender documents, requests for proposals and statements of work) in discussion with potential Post-Collection service providers identified in the REOI process; and

3. Stewardship Ontario will issue an invitation to prospective Post-Collection service providers that are able to manage the defined list of PPP to participate in a competitive procurement process for Post-Collection services.

Prospective Post-Collection service providers will be provided with the following information for each Catchment for which Stewardship Ontario is procuring Post-Collection services:

The Communities within the Catchment boundaries;

The contact information for the Collection service providers for each Community in the Catchment, if it is known at the time;

The expected quantities of PPP generated by each Community in the Catchment and the method of its Collection (e.g., single-stream cart, dual-stream, etc.); and

Details about publicly held transfer stations, material-recovery facilities and other PPP related installed capital within Catchment boundaries, if known.

The competitive procurement process will solicit information that will allow Stewardship Ontario to confirm a Post-Collection service provider’s ability to meet processor qualification standards set by Stewardship Ontario. The competitive procurement process will also solicit bid prices for Post-Collection services, including:

Receiving PPP from vehicles operated by qualified Collectors;

Picking up PPP from depots operated by qualified Collectors;

Consolidating and transferring PPP from qualified Collectors where required;

Preparing PPP for shipment to Diversion End-Markets or downstream processors;

Marketing PPP to Diversion End-Markets;

Transferring PPP to downstream processors, as required;

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Appropriately managing residual materials;

Tracking materials received and shipped to Diversion End-Markets or disposal; and

Reporting to Stewardship Ontario as required.

Post-Collection service providers qualify based on compliance with processor qualification standards and evaluation criteria including but not limited to price, location, capability (operational and reporting), capacity, output to Diversion End-Markets per tonne received and material revenue received.

In assessing best value, Stewardship Ontario will also consider the implications of processor and Diversion End-Market locations on its contract administration activities including, for example, audits and compliance.

With respect to the marketing of processed materials, processors will be incentivized to find the “best” markets for materials (i.e., reliable markets that command the highest commodity prices and that are not at risk of border restrictions) and the agreements will incorporate mechanisms for how Stewardship Ontario receives value for the marketed commodities.

7.10 Standardized List of Materials Collected

The list of accepted and Targeted PPP will be standardized and uniform in all Transitioned Communities. Although Stewards report and pay fees for all PPP, not all PPP has Diversion End-Markets and therefore the list of PPP targeted for Collection will be a subset of all PPP.

The principles for establishing the list of materials targeted for Collection are as follows:

Materials targeted for Collection have Diversion End-Markets with sufficient capacity to avoid the need for storing materials or requiring their disposal; or if no Diversion End-Markets exist, then the materials have alternative management options to landfill that are environmentally preferable; and

Materials can be managed in a manner that minimizes residue and disposal; and by extension, all materials targeted for Collection can contribute to environmental performance.

Where a material is not on the list of Targeted PPP, or where the material does not have a Diversion End-Market, the material will be evaluated against the waste reduction criteria in Section 11 of this Plan to determine the activities necessary to collect and/or recycle the material in the future.

The initial list of targeted materials is included in Appendix B - , and will generally include:

Paper o Paper products o Paper packaging

Plastics o Plastic #1: Polyethylene Terephthalate (PET) packaging o Plastic #2: High Density Polyethylene (HDPE) packaging and film o Plastic #4: Low Density Polyethylene (LDPE) packaging and film o Plastic #5: Polypropylene (PP) packaging o Plastic #6: Polystyrene (PS) packaging

Metals o Steel packaging o Aluminum packaging

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Glass o Glass packaging

Some exclusions will apply within the general categories due to specific characteristics of the material, including but not limited to contamination, hazardous residue, or size. Such exclusions will be communicated to Consumers through Promotion and Education materials. Additions to the list of materials targeted for Collection will be made for operational reasons in response to changing technology and the availability of Diversion End Markets, for example, as the result of waste reduction activities outlined in Section 11. As such, these changes are operational in nature and do not constitute a change to the Plan and are not subject to the provisions of Section 2.4.

Consumers will be encouraged to return packaging that is addressed through the Liquor Control Board of Ontario’s Ontario Deposit Refund Program (ODRP) or Blue Box waste that is packaging associated with products listed for sale by Brewers Retail Inc. (The Beer Store) to The Beer Store for refund.

7.11 Communications, Promotion and Education

Stewardship Ontario will have the primary responsibility to communicate with, and provide Promotion and Education (P&E) materials to Consumers in Transitioned Communities. In many cases, Stewardship Ontario will develop the communications and P&E materials, which will then be delivered by its Collection partners.

Stewardship Ontario will design and deliver an effective resident education program that achieves two primary objectives:

1. Make Consumers and other target audiences aware of the program features and benefits; and

2. Engage and encourage Consumers to make informed and proper decisions concerning the preparation of PPP for Collection in order to increase the amount of Targeted PPP collected and reduce contamination.

The design of the communication activities will be set out annually in a communication and P&E plan.

The principles guiding the development of the communication and P&E plan will be:

Understand Stewardship Ontario’s resident and stakeholder audiences: Identify the various audiences who will participate in the PPP program and assess each group’s information and P&E needs;

Design effective communication and P&E: Ensure that communication strategies, images, messages and tools reflect needs, are clearly understood, overcome perceptual and real barriers, contain a call to action and motivate appropriate behaviour;

Collaboration: Explore opportunities to collaborate with other Ontario stewardship agencies, Communities, retailers, Community-based organizations and others to develop strategies and distribute P&E materials that strive to inform and motivate;

Establish measurement metrics: Establish a benchmark measurement of program awareness, perceptions and reported behaviour against which to track and assess changes pertaining to year-over-year performance;

Maximize the use and effectiveness of in-kind advertising space: Fully utilize advertising space provided by CNA/OCNA Members cost effectively meet communications and P&E needs;

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Deploy an effective mix of communication and P&E tactics: Develop and disseminate a strategic mix of tactics that ensure Consumers and stakeholders are effectively exposed to primary and supportive messaging; and to undertake this in cooperation with Communities and others who have developed and operate successful, mature recycling programs; and

Engage audiences to elicit feedback: Employ contemporary methods of communication interaction (e.g., social media) as well as traditional methods to engage Consumers and encourage them to provide direct feedback regarding program changes and to ask questions.

To assist in the evaluation of communications activities, Stewardship Ontario will conduct research during the year following approval of this Plan to establish benchmark awareness levels.

7.12 Minimizing Stranded Assets

The approach to designing Catchments (Section 7.6.2) transitioning Communities (Section 7.6.3) and procuring Post-Collection services (Section 7.9) will minimize stranded assets as described below.

Create geographic Catchments that promote the logistically efficient consolidation, transfer and Processing of materials and that encourage maximized use of existing capital assets (i.e. private and public material recycling facilities and transfer stations);

Use a market solutions-based approach to procuring Post-Collection services that allows private and public operators to design a comprehensive system to move PPP from Collection to Diversion End-Markets by:

o Provide Communities and the waste management industry with information regarding the inventory of available and publicly held capital assets deployed against waste diversion in Ontario today in order to improve logistic planning and design;

o Provide sufficient time for private and public operators to assess the redeployment, reuse, refurbishing and recapitalization of those assets towards providing Post-Collection services as well as to establish the commercial relationships necessary to do so; and by extension

o Provide Communities with the opportunity to divest, lease out or repurpose public facilities as determined by their desire to participate in Post-Collection procurement or based on the interest of proponents that may be participating in Post-Collection procurements.

8. ENSURING COMPETITIVE, FAIR AND OPEN MARKETS

In the operation of the Blue Box Plan the choices that Stewardship Ontario makes in procuring and paying for PPP Collection and Post-Collection services should not have a negative impact on the competitive dynamic in the marketplace for those services, nor should its choices create barriers to competition under a producer responsibility regulation established under the RRCEA. In this regard, Stewardship Ontario will operate the Plan so as to affect the marketplace in a fair manner including providing parties equitable opportunities to compete to support a fair and open marketplace for Blue Box services.

This section describes the steps that Stewardship Ontario will take to support competitive, fair and open markets. Specifically Stewardship Ontario will:

1. Promote competition and ensure market fairness under the amended Blue Box Program Plan by:

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o Establishing procurement, payment and related administrative practices that do not unduly

restrict competitive markets for PPP Collection and management services; and

o Treating the marketplace in a non-discriminatory and fair manner by applying transparent

and accessible policies, rules and procedures to all participants in a market segment.

2. Avoid creating barriers to competition in the second phase of transition that will result in individual producer responsibility under the RRCEA, and which is predicated on the winding up of Stewardship Ontario by:

o Ensuring that decisions made by Stewardship Ontario during plan operation do not

advantage or disadvantage some Stewards or groups of Stewards under the RRCEA;

o Establishing procurement, payment and related administrative policies, practices and

procedures during the plan’s operation and Stewardship Ontario’s wind-up that do not

adversely affect the competitive dynamic in PPP Collection and management markets that

will continue to operate following the introduction of a regulation under the RRCEA.

8.1 Promoting Competition and Ensuring Market Fairness

Economic efficiency and environmental performance objectives under this Plan must be achieved by fostering competitive markets for the Collection and management of PPP. To ensure competitive markets are promoted Stewardship Ontario will:

Utilize a combination of procurement practices and economic incentives to obtain Collection services directly from private sector service providers in a manner that complies with the Competition Act of Canada and other established practices and procedures designed to ensure competitive procurement;

Ensure that where Communities are acting as Collection contract managers, Stewardship Ontario’s pro forma requirements for ensuring competitive procurement processes for Collection services are reflected in those Communities’ tendering processes;

Ensure that where benchmark prices are used to remunerate Collectors they are established giving consideration to prices realized in competitive procurement processes in Communities with similar geographies, population and other relevant characteristics that used Stewardship Ontario’s pro forma requirements;

Use cost-based assessments where such direct benchmark prices are unavailable or incomplete, which may include giving consideration to historical prices obtained by the Community or to adjust observed market prices for salient differences between the most-like benchmark Community and the Community subject to benchmarking;

Ensure that where Stewardship Ontario uses incentive based remuneration (e.g. for incentivizing private delivery of PPP Collections from multifamily dwellings) the incentives are available to any qualified Collector; and

The size of Catchment boundaries for Post-Collection procurement will be limited to provide opportunity for many Post-Collection service providers to deliver services (See Section 7.6.2);

Stewardship Ontario will establish administrative rules, procedures and practices (e.g. qualifying service providers, registering parties, requiring reporting, making payments etc.) that are non-discriminatory so that administrative barriers to competition are minimized consistent with the WDTA, the Competition

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Act, and the Minister’s Request Letter, which requires a fair and open marketplace for Blue Box services, as follows:

Ensure that qualification, procurement and payment practices will:

o Not unduly limit the number of Collection and Post-Collection service providers by:

▪ Providing exclusive rights for a supplier to provide goods or services outside of those procured through competitive procurement10;

▪ Establishing qualification standards beyond those necessary to deliver the objectives set forth in the Minister’s direction, the WDTA and its regulations and this Plan; and

▪ Creating geographical barriers other than those necessary to establish the basis on which service providers will be procured to provide Collection and Post-Collection management of PPP.

o Not limit the ability of Collection and Post-Collection service providers to compete by:

▪ Limiting their ability to set the prices for goods or services proposed in competitive procurements;

▪ Limiting the freedom of service providers to advertise or market their goods or services that are unrelated to the services provided to Stewardship Ontario;

▪ Setting performance standards that are discriminatory and which significantly raise costs to some service providers relative to others (especially by treating incumbents differently from new entrants);

▪ Not extending Community contracts beyond their natural expiry, including any renewal terms, where existing Community Collection contracts with service providers are amended to align with standards provided by Stewardship Ontario; and

▪ Reduce the incentive for service providers to compete by requiring or encouraging information on proponent prices, sales or costs to be public.

In addition to ensuring competition under plan operation these measures will also ensure the competitive dynamic in PPP Collection and management markets that may continue to operate under a regulation under the RRCEA.

8.2 Preventing Barriers to Competition Under Individual Producer Responsibility Regulation Under the RRCEA

When Stewardship Ontario has fully assumed the responsibility for collecting and managing PPP in every Community choosing to transition, it will be administering several hundred commercial contracts with Communities and private service providers.

This Collection contract portfolio will include, at minimum, contracts with:

Communities that are acting as Collection contract management agents;

10 On occasion, Stewardship Ontario may identify additional goods or services that are natural extension of existing contracts, in which case it may consider amending its existing contracts to include the goods or services. On other occasions, Stewardship Ontario may enter into sole source or single source contracts as part of a pilot study.

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Private Collection service providers providing residential PPP Collection services procured through competitive procurement;

Public Collection service providers providing residential PPP Collection services;

Private Collection service providers providing PPP Collections from multi-family dwellings under financial incentives; and

Private depots providing PPP Collection services.

Stewardship Ontario will also hold a portfolio of Post-Collection contracts with any combination of individual private and public service providers and consortia of those service providers.

The extent to which competition occurs in service provider and producer markets under the RRCEA will be determined by regulatory design (i.e., requirements on responsible persons and other regulated persons), the form and design of the contracts held by Stewardship Ontario and the method by which, “contracts held by Stewardship Ontario for the Collection and management of PPP will be managed upon wind up of the Blue Box Program”.11

8.2.1 Contract Design

To secure the most favorable price responses from service providers, Stewardship Ontario will enter into Collection and Post-Collection contracts for a period of time that is appropriate for the type of service and capital investment required by the successful proponent. The terms of these contracts will necessarily extend beyond the date by which all Communities are expected to transition.

To ensure that all stewards regulated under the RRCEA have equal access to the services and financial arrangements contained in these contracts, all Collection and Post-Collection contracts held by Stewardship Ontario will contain provisions to make them both assignable and subject to necessary amendments to align with regulatory requirements under the RRCEA upon wind-up of the Blue Box Program.

8.2.2 Assignment of Collection contracts

Each Collection and Post-Collection contract held by Stewardship Ontario will allow, without restriction, for its assignment to a third party “Assignee(s)” where the Assignee(s) are identified in a wind-up plan prepared pursuant to s. 14 (1) WDTA and the plan is approved by the Authority under s. 14 (15) WDTA. The details of the assignment will be contained in the wind-up plan pursuant to s. 14 (12) 4, and the transfer of any relevant related data to Assignees pursuant to s. 14 (12) 5. WDTA.12

Assignee(s) will only be identified in a wind-up plan if the Assignee(s) is willing to receive the contracts in question.

11 Minister’s Request Letter. 12 The wind-up of Stewardship Ontario and regulation of responsible persons under the RRCEA is a form of deregulation. How

responsible persons convene themselves to discharge their obligations under the RRCEA will be largely unregulated unlike the way in which Industry Funding Organizations are convened and regulated under the Waste Diversion Act 2002 (and the WDTA as its successor statute). This change marks a distinct policy transition and, depending on the design of the PPP regulation, may require the wind-up plan to establish a comprehensive set of rules and processes to provide responsible persons with access to the contracts that underpin the common Collection system established during the operation of the amended Blue Box Program Plan. See: Competition Law and Deregulation in Network Industries University of Toronto, Faculty of Law Symposium paper: Essential Facilities and the Duty to Facilitate Competition. John J. Quinn and Glenn F. Leslie June 14, 1996

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Potential Assignee(s) will only self-identify when the need to receive some or all of the contracts held by Stewardship Ontario is established. The determinants of that need are the requirements placed on responsible persons under the RRCEA PPP regulations.

As such, the RRCEA PPP regulations must be promulgated well before Blue Box Program wind-up planning begins to allow responsible persons to assess their options for gaining compliance.

Accordingly, subsequent to the promulgation of the RRCEA PPP regulations, a process will need to be established for potential Assignee(s) to identify themselves to the Authority, for allowing prospective Assignee(s) to evaluate the contracts held by Stewardship Ontario and for prospective Assignees to then propose the means by which they would receive those contracts (including any amendments they may wish to make).

As discussed above, the wind-up plan submitted to the Authority for approval will identify the designated Assignee(s) and the process for making the assignments to them.

9. DISPUTE RESOLUTION PROCESS

The objectives of the dispute resolution process are to manage disputes to resolution, rather than adjudication, earlier and faster and at a reduced cost to all parties involved.

Stewardship Ontario will seek to balance the principles of access, efficiency, fairness and equitable outcomes in the design of its dispute resolution mechanisms. Dispute resolution processes will be tailored to the nature of disputes and will be embedded in commercial agreements between Stewardship Ontario and its service providers. A general dispute resolution process will be posted to the Stewardship Ontario website to govern disputes where there is no established dispute resolution process between Stewardship Ontario and another party with which it conducts business.

10. PROGRAM PERFORMANCE

10.1 Tracking Program Performance for Non-Transitioned Communities

Stewardship Ontario will report the total tonnes reported by each Community that has not transitioned. The source will be the verified Datacall as administered by the Authority

10.2 Tracking Program Performance for Transitioned Communities

The diversion target for the Blue Box Program has been set at 75% of PPP Supplied by Stewards to Transitioned Communities. The diversion target calculation is:

D𝑖𝑣𝑒𝑟𝑠𝑖𝑜𝑛 𝑃𝑒𝑟𝑓𝑜𝑟𝑚𝑎𝑛𝑐𝑒 𝑓𝑜𝑟 𝑌𝑒𝑎𝑟 𝑛 = 𝑇𝑜𝑛𝑛𝑒𝑠 𝑜𝑓 𝑃𝑃𝑃 𝑀𝑎𝑛𝑎𝑔𝑒𝑑13 𝑖𝑛 𝑌𝑒𝑎𝑟 𝑛

𝑇𝑜𝑛𝑛𝑒𝑠 𝑜𝑓 𝑃𝑃𝑃 𝑆𝑢𝑝𝑝𝑙𝑖𝑒𝑑14 𝑖𝑛 𝑌𝑒𝑎𝑟 𝑛 −2

13 In Transitioned Communities. 14 In Transitioned Communities.

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10.2.1 Method for Calculating the Diversion Target

Stewardship Ontario will begin performing composition audits on inbound material from a representative15 sample of Transitioned Communities16 (A below). The results of the composition audit process will allow Stewardship Ontario to determine the total quantity of Targeted PPP managed (i.e., with Diversion End-Markets), and to exclude the quantities of Non-PPP, Non-Targeted PPP and PPP without Diversion End-Markets from the total quantity of inbound material. This composition will be applied to all inbound loads delivered by all Transitioned Communities to produce the numerator for the diversion performance calculation as illustrated by “A” in Figure 7 below.

10.2.1.1 Figure 7

To report on diversion performance for a Transitioned Communities, Stewardship Ontario will prorate the total PPP Supplied by Stewards (B in Figure 7 above) into Ontario by the population of all Transitioned Communities17. It will then divide the total amount of Targeted PPP managed that originated from Transitioned Communities by the total amount of Supplied PPP prorated for all Communities. Where a Community transitions on a date other than January 1st of a given year, Stewardship Ontario will prorate the calculated Supplied quantities based on the transition date.

10.2.2 Timeline for Reporting the Diversion Target

Stewardship Ontario will report the program’s diversion performance for the 202118 calendar year and each year thereafter. For 202019, Stewardship Ontario will report the total inbound quantity of material collected from Transitioned Communities because there will not be sufficient composition audit data nor sufficient representation from all Community types to apply audit results to all inbound PPP from Transitioned Communities.

15 It is cost prohibitive to conduct statistically significant composition audits for every Transitioned Community and therefore a statistically significant representation of Transitioned Communities will be defined for use in the composition audit process. The audit results will then be applied to all inbound tonnes from all Transitioned Communities. 16 Communities will be candidates for inclusion in the representative samples three months after they have transitioned to allow time for operational and reporting processes to stabilize. 17 Use of Supplied quantities is a requirement of the RRCEA. Previously, the denominator was based on the quantity of material generated. 18 Assuming that the Plan is approved by June 1, 2018. 19 Assuming that the Plan is approved by June 1, 2018.

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10.2.3 Timeline and Approach to Achieving a 75% Diversion Rate

Stewardship Ontario will achieve the aggregate province-wide 75% diversion target two years following the transition of all Communities. Actions Stewardship Ontario will take to achieve the target include:

Ensuring appropriate and convenient access to PPP Collection services;

Increasing participation by encouraging Consumers to utilize available Collection systems;

Resolving technical and convenience barriers in multi-family Collection systems;

Increasing capture rates by encouraging Consumers to place Targeted PPP in the PPP Collection system rather than the garbage Collection system; and

Standardizing the list of materials collected.

Stewardship Ontario estimates that by the second year following the transition of all Communities, it will have increased the annually managed tonnes by 91,000 tonnes over 2017 performance, as in Figure 8 below.

10.2.3.1 Figure 8

Action Assumption Incremental Tonnes

Addition of 300,000 multi-residential households 80 kg/household 24,000

Standardize the list of materials collected 3% increase 25,000

Increased capture due to Promotion & Education 5% increase 42,000

TOTAL 91,000

Stewardship Ontario will require a period of time to assess the impact on program performance resulting from changes to the types of materials designated as PPP (e.g., paper for general use) and the establishment of a standardized list of materials accepted in recycling programs.

10.3 Material-Specific Management Targets for PPP Supplied to Transitioned Communities

Stewardship Ontario is required to establish material-specific management targets for PPP Supplied by Stewards to Transitioned Communities.

In setting these targets, Stewardship Ontario will adopt the material-specific categories included in Ontario Regulation 386/16. The categories for material-specific targets are:

Paper

Plastic

Metal

Glass

10.3.1 Material-Specific Targets

Material-specific management targets represent the minimum percentage share of each material type that Stewardship Ontario will seek to manage. For the purpose of the Blue Box Program, the methods of

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managing the materials will allow for the material or part of the material to be, in accordance with Ontario standards and regulations:

Reused;

Used in the making of new products, packaging or other activities in Diversion End-Markets; or

Used as a nutrient for improving the quality of soil, agriculture or landscaping.

The material-specific management targets have been set with the following objectives:

In aggregate, the achievement of all material-specific management targets will enable the achievement of the overall diversion target of 75%;

The focus on increased performance should be on materials with existing diversion rates below 75%; and

Material-specific targets should be achievable within two years following the transition of all Communities.

Material-specific targets for 2027 are listed in Figure 9 below.

10.3.1.1 Figure 9

Material Target Current

Performance20 Improvement

Percentage

Paper 95% 94% + 1.1 %

Plastic 50% 35% + 42.9 %

Metal 65% 58% + 12.1 %

Glass 75% 73% + 2.7 %

Material-specific performance shall be calculated as outlined in Section 10.2 above and using the four material-specific reporting categories proposed.

10.4 Other Performance Indicators

In addition to the program and material-specific diversion rates to be reported as outlined in Sections 10.2.1 and 10.3.1 above, Stewardship Ontario will report the following performance indicators on an annual basis:

Total Supplied Tonnes as reported by Stewards;

Number of Stewards;

Total tonnes of collected residential material (PPP and Non-PPP) from Transitioned

Communities;

Total tonnes directed to Diversion End-Markets from Transitioned Communities;

20 Assumption based on changes to definitions of PPP and other proposed changes in this Plan.

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Total tonnes directed to end-markets other than Diversion End-Markets or Disposal, such as

recovery;

Percentage of total tonnes from Transitioned Communities directed to Diversion End-Markets

by country21;

Total number of Transitioned Communities;

Number of households serviced in Transitioned Communities;

Percentage of households with access to Collection services for Transitioned Communities;

Cost per tonne for all services delivered in Transitioned and Non-Transitioned Communities;

Cost per household for all services delivered in Transitioned and Non-Transitioned Communities;

and

Diversion performance for sub-categories within the four material-specific reporting categories

as needed to inform Stewards of actions taken to support waste reduction initiatives (see

Section 11).

Stewardship Ontario will report Consumer awareness performance indicators at least every three years.

11. WASTE REDUCTION

Reduction or “waste reduction” means the minimization of waste generated at the end-of-life of products or packaging, including through activities related to design, manufacturing and material use22. Reducing the amount of Paper Product or Packaging, reuse and increasing recyclability and recycling are all measures to effect reduction23. Where Stewards bear the cost of the end-of-life management of their Paper Product and Packaging choices, consideration of opportunities to reduce, reuse and increase both recyclability and recycling is expected to increase.

Accordingly, the following measures will be taken to advance waste reduction:

Where PPP is being collected and managed in Transitioned Communities, communicate the material’s Collection and management performance to Stewards. Where such Collection and/or management performance is assessed to be low, determine and communicate to the responsible Stewards the following:

o Why the performance is low;

21 The actual end-market name and location is commercially confidential to the Post-Collector. Stewardship Ontario will approve the use of Diversion End-Markets by a Post-Collector and report the end-market name and address to the Authority on an annual basis. 22 Resource Recovery and Circular Economy Act, 2016, S.O. 2016 23 The Packaging choices that Stewards make are driven by factors including but not limited to utilizing recyclable materials, maintaining product integrity during handling and transport, ensuring food safety, providing marketing distinction and reducing shipping cost. In some cases, there may be tension when trying to satisfy all objectives – as an example, a lightweight package that reduces raw material use, transportation cost and energy use may not currently be readily recycled at end-of-life.

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o Recommendations for operational and technological innovation and Promotion and Education that can be undertaken by Stewardship Ontario and its commercial partners to improve Collection and management performance;

o The costs of operational and technological innovation and promotion and education that are being undertaken by Stewardship Ontario and its commercial partners to improve Collection and management performance; and

o How these costs are reflected in the responsible Stewards’ fees for the particular paper product or package.

Where a paper product or package is not being collected and managed in the transitioned system, determine why not and communicate to the responsible Stewards the following:

o The reason it is not being currently collected and managed;

o Recommendations for technological and operational innovation and Promotion and Education that can be undertaken to establish Collection and management of the paper product or packaging in question;

o The cost of the efforts toward technological and operational innovation and Promotion and Education necessary to establish Collection and management of the paper product or packaging in question; and

o How these costs are reflected in the responsible Stewards’ fees for the particular paper product or package.

Stewardship Ontario may convene collaboration forums comprised of a combination of experts with a mandate to identify and bring to market solutions to improve the Collection and management of PPP. Collaboration forums may be composed of Stewards, Collectors, the waste management industry, secondary processors, or other qualified individuals or producer responsibility programs (e.g., Recycle BC or European programs).

Whether or not the paper product or packaging is being collected and managed in the transitioned system, Stewardship Ontario will employ a fee setting methodology for purposes of financing the Plan. The fee methodology will enable the allocation of cost to material categories in order to fund remedial actions to improve the diversion performance of poorly performing materials and actions necessary to allow items that are not currently collected, to be collected and managed. The Fee Setting Methodology will contain mechanisms that advance the Minister’s interest in driving waste reduction of PPP but it is understood to be but one of a number of tools at Stewardship Ontario’s disposal to advance the waste reduction objectives. Methodologies for calculating the various inputs to the fee setting process as well as supply chain contract and service designs are examples of additional tools that can provide the necessary economic incentives to incent waste reduction.

Stewardship Ontario will ensure that performance metrics are available annually to provide evidence of the requirement for these investments.

Stewardship Ontario will undertake research to establish Collection and management of the affected materials that are not currently targeted for Collection or to address those materials that have low diversion performance in the Full Producer Responsibility system.

Stewardship Ontario will identify the materials in question and may notify affected Stewards of the need for research and development and the specific areas to be studied.

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In this case, Stewards may be provided an opportunity to propose their own research and development plan to Stewardship Ontario. A proposal by Stewards to undertake such planning will at a minimum specify:

The work the Steward(s) and their research partners plan to undertake with regard to operational and/or technological changes needed to effectively collect and manage the material and for its receipt by stable Diversion End-Markets;

The timeline for submitting their findings to Stewardship Ontario; and

The method by which Stewardship Ontario will be involved in the ongoing research.

The Stewards’ plan will propose any technological and operational changes to the Collection and Post-Collection management of PPP necessary to address the deficiencies identified by Stewardship Ontario. Where Stewardship Ontario accepts the proposal Steward(s) and their research partners will provide regular project updates to Stewardship Ontario.

Where such research is successful, Stewardship Ontario will assess the cost of the necessary changes to the PPP Collection and management system in order to implement the technologies and practices proposed by the research and development work. Stewardship Ontario will incorporate the costs of these changes in fees charged to Stewards of the affected materials.

Where the affected Stewards develop solutions through their own research and development the affected Stewards will retain any intellectual property developed through their efforts.

Where affected Stewards decline the opportunity to undertake the research and development necessary to improve the environmental performance of the respective materials in question, or where Stewardship Ontario rejects the proposal, or where Stewardship Ontario chooses an alternate approach to research and development, Stewardship Ontario will undertake and fund (via its assessment of material-specific stewardship fees) the research and development effort.

The affected Stewards will bear the costs of implementing and operating the proposed changes as part of their assessed stewardship fees.

11.1 Timeline for Waste Reduction Initiatives

Upon Plan approval Stewardship Ontario’s first priority will be the development of Collection strategies that allow for the effective Collection of expanded and extruded polystyrene foam to enable these materials to be included in the list of collectable materials in the Collection and Post-Collection statements of work to be finalized in November 2018.

Research will be conducted in 2019 to identify the list of problematic materials requiring Collection and material management solutions. Once identified, a design phase will initiate to allow for the continuous expansion of the materials collected and managed. The research, design and implementation phases will continue throughout the Plan duration as depicted in Figure 10 below.

11.1.1 Figure 10

2018 2019 2020 2021 2022 2023 2024 2025

Research & Design Activities

Determine Foam Collection Strategy

Research – Identify Top X Problematic Materials

Design – Problematic Material(s) #1 – Collection & Management Strategy

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Design – Problematic Material(s) #X – Collection & Management Strategy

Implementation Activities – Expanding Collection & Improving Management

Foam Collection – Transitioned Communities

Problematic Material(s) #1 – Collection – Transitioned Communities



12. PROGRAM FINANCING

Stewardship Ontario has a responsibility to deliver an efficient and effective PPP stewardship program. Stewards are responsible to pay fees that are sufficient to implement and operate the Plan. The Plan has two major phases:

Phase A – Transition Planning

Phase B – Community Transition

The 2018 fees are approved and will not change. Activities required to support Phase A activities in 2018 will be funded using program reserves.

Stewardship Ontario will, beginning with the 2019 fee schedule, incorporate new cost items within the annual business plan and budget published to Stewards annually. These new cost items will be incorporated at a measured pace and in alignment with its increasing financial and management responsibilities.

Stewardship Ontario incorporates the following costs into its annual budget, which are inputs to calculate material fees:

i. Share of Supply Chain costs for Non-Transitioned Communities – the amount the Authority has determined to be the Community payment obligation;

ii. Promotion and Education and Market Development – costs to educate Ontario Consumers and invest in performance improvement;

iii. Program Management – costs to operate the program; and iv. Regulatory Costs – the Authority charge to Stewardship Ontario for program oversight.

These cost items will remain components of the Stewardship Ontario annual budget. To fund the Transition Planning and the Community Transition phases, Stewardship Ontario will add the cost items in Figure 11 below to the program budget.

12.1 Figure 11

Anticipated Year Cost Item

2019

1 - Implementation Plan resources

2 - Reserve accumulation

3 - Cost of Waste Reduction investments

2020

1 - Implementation Plan resources

2 - Reserve accumulation


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4 - Transition Plan support resources

5 - Incremental Supply Chain costs for transitioning Communities

2021 – 2025

1 - Transition Plan support resources


3 - Incremental Supply Chain costs for transitioning Communities

Stewardship Ontario will publish the budget and fees annually to Stewards in Q4 of each year to allow Stewards to understand the basis of their fees and to plan for the incremental annual expense to be incurred beginning in 2019 until a steady state is achieved in 2025.

13. REGISTRATION, REPORTING, RECORD KEEPING AND AUDITING

Stewardship Ontario is responsible to provide Stewards with a registration and reporting system.

13.1 Registration & Reporting

Stewardship Ontario will facilitate the registration of Stewards and to provide Stewards with an online reporting system, support services and tools.

13.2 Record Keeping

Stewardship Ontario is responsible for maintaining the confidentiality and security of reported information.

13.3 Auditing

Stewardship Ontario is subject to the audit provisions established by the Authority. These provisions require that Stewardship Ontario disclose Steward registration and reported information upon request.

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APPENDIX A - CHANGES TO THE 2016 MUNICIPAL DATACALL USER GUIDE

This section outlines the eligible and ineligible costs and revenues for the purpose of calculating payments to Communities pursuant to Section 6. These eligible and ineligible costs remain unchanged from those used to calculate the 2018 steward obligation, except for the inclusion of Ineligible Costs items 1, 2 and 3.

Operating Costs means:

Service Delivery Costs include expenditures for the Collection and Processing of residential PPP, whether the service is delivered by the Community, contracted to the private sector, or a combination thereof.

Contracted Service Delivery Costs

If the service is contracted to the private sector, the direct service delivery cost is the Collection and Processing fees charged by the contractor to the Community for the management of PPP.

Direct Service Delivery Costs

If the service is delivered by the Community, direct service delivery costs include, but are not limited to:

Payroll costs of recycling Collection truck drivers and sorters at a material recovery facility for

the management of PPP;

Services such as utilities, insurance, equipment repair and maintenance to enable the

management of PPP;

Supplies such as fuel, baling wire, replacement Blue Boxes;

Rent or lease costs for buildings, equipment or vehicles in use by the Community for PPP

Collection and management on or prior to August 14, 2017;

Taxes and payments-in-lieu of taxes;

Interest on debt to acquire buildings, equipment or vehicles in use by the Community for PPP

Collection and management on or prior to August 14, 2017; and

The non-refundable portion of the HST where applicable.

Capital Costs means:

Where the capital costs do not form part of the contract service price from a private sector contractor, this includes the amortized capital cost, based on the Datacall Amortization Schedule provided below, of Community owned Collection vehicles, material recovery facilities, fixed and mobile equipment within the material Collection facility, and Collection containers, in use by the Community for PPP Collection and management on or prior to August 14, 2017. Grants for capital improvements will be subtracted from the capital costs to calculate the eligible capital costs under the program prior to amortization.

Promotion and Education Costs means:

Resident awareness and education costs include the costs to promote the use of the recycling program and educate residents on proper local PPP recycling procedures.

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The actual costs incurred by the Community to conduct resident awareness and education of

PPP recycling as submitted through the Datacall for activities such as graphic design, production

costs, printing, postage, linage rates, air time, etc.

Administration Costs means:

Administration costs are costs incurred by Communities in support of PPP program operations. Eligible administration costs include the portion of the following cost items that are attributable to residential PPP program operations:

Financial, including accounts payable and receivable, purchasing, payroll and audit;

Human resources, including health and safety, labour and employee relations, training and

development;

Information technology, including electronic databases to record and track Blue Box tonnage

information; and

Legal, only for legal costs directly related to direct service delivery issues such as review of

tender documents or contract disputes.

Calculated Administration Costs means:

the lesser of:

Administration Costs; or

A specified percentage of total Operating Costs, Capital Costs and Promotion and Education

Costs, being:

o 5% for Communities that provide services directly; and

o 3% for Communities that contract for one or more services.

Ineligible Costs include

1. Costs related to transition including:

Activities undertaken in anticipation or preparation for transition

Penalties or fees incurred to terminate contracts to facilitate transition

Decommissioning, transferring, selling or otherwise disposing of assets in anticipation of

transition (This is not to be confused with the treatment of Community assets not utilized in

transitioned Post-Collection systems developed through competitive procurement processes -

See Section X)

Unamortized capital costs that extend beyond transition date

Severance or other employee termination-related costs related to transition.

2. Costs related to service level changes approved after August 14, 2017 including:

Changes in the frequency of service

Changes in Collection methods (e.g. shift from multi-stream to single stream and vice versa,

from depot to curbside Collection and switching Collection containers types).

3. Costs related to contract operations and management deficiencies

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44

Specifically, penalties or fees incurred by Communities as levied by service providers resulting

from service level failures (e.g. contamination in materials in-bound to processors) or other

deficiencies in Community performance as in terms of their agreements with service providers.

4. The cost of land.

Gross Revenue means:

Revenue from the sale of PPP is from the Community’s general ledger and includes:

Revenue received by the Community for the sale of PPP;

Revenue from service fees, including Processing fees and depot access fees, charged to other

Communities for the management of residential PPP;

Revenue from the sale of Collection containers; and

Revenue from grants and other funding that are intended to offset PPP Collection, management

or resident awareness and education costs.

Excluded from Gross Revenue is revenue retained by private sector contractors under revenue sharing agreements.

Datacall Amortization Schedule

Blue Box Collection Costs:

Items Purchased Years Amortized

Owned and Operated Recycling Vehicles 7

Purchase of Blue Boxes 3

Purchase of Curbside or Multi-Residential Carts

10

Purchase of Roll-Off Bins / Compartmentalized Trailers

3

Other Uncategorized Capital Purchases Define amortization

period, up to 20 years

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45

Blue Box Processing Costs:


Purchase of MRF Building 20

Purchase of initial MRF Equipment, Major Expansions, Major Retrofits, Weighscales

10

Purchase of Minor Expansions, Minor Retrofits

5

Purchase of Rolloff Containers / Dumpsters 5

Purchase of Rolling Stock 3


period, up to 20 years

Blue Box Depot/Transfer Costs:


Purchase of Depot / Transfer Building 20

Purchase of initial Depot / Transfer Equipment, Major Expansions, Major Retrofits, Weighscales

10

Purchase of Minor Expansions, Minor Retrofits

5

Purchase of Rolloff Containers / Dumpsters 5

Purchase of Rolling Stock 3


period, up to 20 years DRAFT


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APPENDIX B - INITIAL LIST OF PPP TARGETED FOR COLLECTION IN TRANSITIONED COMMUNITIES

Material Included Exclusions

Paper Products

Newsprint

Magazines and Catalogues

Telephone directories

Loose paper, Notebooks, Note pads, Diaries, Cardstock, Brochures, etc.

Envelopes Envelopes with plastic bubble filling

Wrapping Paper Foil wrapping paper; Paper with non-fibre components

Calendars All disposable fibre dishware

File folders Hanging folders with metal inserts

Greeting cards Cards containing batteries

Corrugated containers and boxes Waxed corrugated

Boxboard and paper cores (rolls)

Kraft paper

Molded pulp

Aseptic and Gable Top cartons, Polycoat containers and cups

Foil laminated containers, waxed containers, other paper laminates

Plastic Packaging

Plastic #1: Polyethylene Terephthalate (PET) bottles, jars and packaging

Foamed PET; Strapping; Beverage alcohol containers on deposit; Film

Plastic #2: High Density Polyethylene (HDPE) bottles, jars, packaging and film

Foamed HDPE; Containers with metal handles; Squeeze tubes; Hangers

Plastic #3: Polyvinyl Chloride (PVC)

Plastic #4: Low Density Polyethylene (LDPE) bottles, jars, packaging and film

Foamed LDPE; Squeeze tubes; Hangers

Plastic #5: Polypropylene (PP) bottles, jars and packaging

Foamed PP; Squeeze tubes; Paint cans with metal; Hangers; Film

Plastic #6: Rigid polystyrene (PS) and Expanded Polystyrene (EPS/XPS)

PS Film

Plastic #7: Other Mixed Plastics, Polylactic Acid (PLA), Polyhydroxyalkanoates (PHA), Polyhydroxybutyrate (PHB), Unmarked Packaging, Film, Multi-Laminated Packaging (e.g., pouches, net-style bags)

Metal Packaging

Steel food and beverage containers

Steel paint containers Paint containers containing paint

Other steel packaging Aerosol containers; Hangers; Strapping

Aluminum food and beverage containers Aluminum laminated packaging

Other aluminum packaging; Aluminum foils; Aluminum trays/plates

Aerosol containers;

Glass Packaging Clear and coloured glass bottles and jars Beverage alcohol containers on deposit

Changes to the list of materials targeted for Collection will be made for operational reasons in response to changing technology and the availability of Diversion End-Markets, for example, as the result of waste reduction activities outlined in Section 11. As such, these changes are operational in nature and do not constitute a change to the Plan and are not subject to the provisions of Section 2.4. Stewardship Ontario will provide Consumer-friendly lists of the inclusions and exclusions on its website.

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APPENDIX C - SAMPLE TERMS AND CONDITIONS

The following are sample terms and conditions to provide service providers with information on the types of requirements that may be included in commercial agreements.

Curbside Collection Services

Collector will collect In-Scope PPP at Curbside from all Customers within the defined Service Area

Service area and household count can be amended through a defined change process on a quarterly basis.

Collector will collect all In-Scope PPP from all Customers that: (I) are placed in Containers (including both Collector-provided and Customer-owned Containers); and (II) any Corrugated Cardboard, tied securely and stacked by the Customers’ Container (or stacked alone if no Container is present).

Collector will abide by the contamination management protocol.

May not collect Non-PPP under this agreement.

Pick-up in-Scope PPP placed by Customers at the Curb along the Collection vehicle route which may be a Public Street or a Private Road where service vehicles can navigate the Private Road and the owners have agreed to allow service vehicles access.

Curbside Collection on a bi-weekly basis, except that curbside Collection may be conducted on a weekly basis where the Community is already providing curbside Collection on a weekly basis.

Collector will not compact In-Scope PPP in Curbside Collection vehicles at a ratio higher than X:1.

Collector will make Collections in an orderly, non-disruptive, and quiet manner, and will return Containers (including, in the case of Carts, with their lids closed) in their set-out location in an orderly manner. Location of Containers should not block sidewalks, driveways, or on street parking.

Collector will monitor the quality of In-Scope PPP set out for Collection. Customers with more than the listed percentage by weight of Non-PPP and Non-Targeted PPP items will receive a written notice from Collector to reduce the quantity of Non-PPP and Non-Targeted PPP items.

Customers that receive three or more written notices per calendar quarter (three months) will be contacted by the Collector by phone or in person to resolve the issue. If the quantity of Non-PPP and Non-Targeted PPP items is not reduced to less than the requisite yearly percentage by weight after a minimum of three (3) attempts to educate the Customer, Stewardship Ontario may temporarily remove the Customer from the Service Area.

Containers

Collector will, at Collector’s cost, provide re-usable Containers that provide Customers with sufficient volume to accommodate In-Scope PPP generated by the Customers between Collections so that Container capacity is not a barrier to Customer use of the Curbside Collection service.

Designated Post-Collection Service Provider

Collector will deliver all collected materials to the Designated Post-Collection Service Provider in a prescribed manner.

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The point of acceptance will be prescribed in the agreement and will generally fall within a XX minute drive from an urban Community boundary at the point of least distance to the facility operated by the Post-Collection Service Provider. If the Service Area is not in an urban area the Post-Collection Service Provider will accept delivery of In-Scope PPP from the Collector at a location no more than YY kilometers from the Community boundary at the point of least distance to the facility operated by the Designated Post-Collection Service Provider.

Customer Service and Management

As part of Curbside Collection, Collector will provide the following Services.

Facilitate access to a Customer service office and call center.

Collector will ensure a digital record all Customer complaints and service requests.

Record and Reporting Requirements

Collector will meet record keeping and reporting requirements, for example:

Tonnage by Collection date and weight scale ticket (which must include the Collector name and truck number); and

Customer communications related to Curbside Collection including telephone calls, letters, e-mails, text messages or webpage messages received.

Contamination Management Process

To ensure that the quality of the collected PPP consistently improves over time the Collector will participate in a “Contamination Management Process” in order to achieve the following (as updated from time to time):

1. A Contamination Ceiling – the maximum level of acceptable contamination expressed as a percentage of Non-PPP and Non-Targeted PPP in total collected volumes in-bound for Post-Collection management.

2. A Contamination Target as a percentage of Non-PPP and Non-Targeted PPP in collected volumes in-bound for Post-Collection management.

The Contamination Management Process involves the following steps:

Step 1: Identify Candidate Collectors

A Collector will only be considered a candidate for the application of the Contamination Management Process 12 months after a given Community has transitioned.

In due course of operating the program, Stewardship Ontario will undertake composition audits of collected materials in transitioned Communities. As a result of this ongoing monitoring, Collectors may fall into one of three categories:

1. Collectors for whom statistically significant composition audit data24 is available

24 Stewardship Ontario will seek to strike a balance between the cost of composition auditing and the quality of the resulting data. Therefore, it does not expect to complete a statistically significant number of composition audits on PPP from every Community and for some Communities, no composition audits will be completed unless required by the Contamination Management Process.

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2. Collectors for whom some composition audit data is available, but where the data is not

statistically significant

3. Collectors for whom no composition audit data is available

These data and ongoing field observations may trigger the Contamination Management process in one of three ways:

1. Face value assessment of empirical data indicates contamination levels exceed the ceiling;

and/or

2. Observation of materials in-bound for Post-Collection management indicates contamination

levels may exceed the ceiling; or

3. A random selection of a Collector has been made

Once a Collector has been identified as a candidate for the application of the Contamination Management Process, it will progress to the next steps.

Step 2: Notify Collector that the Contamination Management Process has been activated

1. Stewardship Ontario will notify the Collector that the Contamination Management Process has

been activated;

2. Within 15 business days of notification, Stewardship Ontario and the Collector will meet to:

a. Discuss short term remediation plans and a test timeline where the ‘baseline test’

timeline will not exceed 90 days from notification

b. Agree the number and timing of contamination sampling where the number of samples

in the baseline is not less than 10 and conducted over not less than a 3 month period

3. Conduct tests and review Contamination Result where:

Contamination Result = Sum (Non-PPP + Non-Targeted PPP) ÷ Total Quantity Collected

4. Where baseline tests indicate that the Contamination Result exceeds the Contamination Ceiling,

the Collector shall produce a remediation plan and review the remediation plan with

Stewardship Ontario within 30 days outlining what activities will be undertaken to reduce

contamination levels

Step 3: Improve quality and retest

1. Conduct retests based on timeline and count of tests agreed.

2. Review results.

3. Where results indicate the Collector’s remediation plan is effective and contamination levels in

excess of the Contamination Ceiling have been reduced by at least 50%, Stewardship Ontario

and the Collector will repeat Step 3 one time and on the same terms with no financial penalty to

the Collector.

4. Where results indicate the Collector’s remediation plan is ineffective and contamination levels

remain in excess of the Contamination Ceiling and have been not been reduced by at least 50%,

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Stewardship Ontario and the Collector will repeat Step 3 one time and on the same terms. The

cost of the audits shall be borne by the Collector.

Step 4: Apply or Absolve Collectors of a Service Level Failure Credit (SLFC)

1. Stewardship Ontario will conduct test and review results.

2. Where results indicate the Collector has fallen below the Contamination Ceiling, the Collector

will exit the Contamination Management process until such time as their re-entry is triggered by

Step 1.

3. Where results indicate the Collector remains in excess of the Contamination Ceiling,

Stewardship Ontario may:

a. charge the Collector for the Post-Collection expense associated with the tonnes in

excess of the Contamination Ceiling; and/or

b. apply a Service Level Failure Credit.

4. The Collector will remain in Step 4 until they fall below the Contamination Ceiling.

Collector performing better than the Contamination Target

Collectors may trigger the Contamination Management Process for the purpose of earning a Contamination Process Reward by completing the following process steps:

Step 1: Notify Stewardship Ontario

1. Collectors will provide Stewardship Ontario notice of its request to trigger the Contamination

Management Process.

2. Within 15 business days of notification, Stewardship Ontario and the Collector will meet to:

a. Discuss test timeline where the ‘baseline test’ timeline will not exceed 90 days from

notification.

b. Agree to the number and timing of contamination sampling.

3. Conduct tests and review results where the number of samples in the baseline is not less than

10 and conducted over not less than a 3 month period.

Step 2: Evaluate results and determine Contamination Reward eligibility

1. Where the Contamination Result is greater than the Contamination Target, the Collector will be

charged for the cost of the contamination samples.

2. Where the Contamination Result is greater than the Contamination Ceiling, Stewardship Ontario

may notify the Collector that the Contamination Management Process has been initiated.

Where the Contamination Result is less than the Contamination Target, Stewardship Ontario will pay the Collector a Contamination Reward.

Service Level Failures

The following are considered service level failures that may be subject to Service Level Failure Credits.

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Service Level Failure

1 Failure to provide a required report on time.

2

Failure to separate Curbside Collection of In-Scope PPP collected from Customers in Service Area from materials collected outside of the Service Area without prior written approval.

3 Delivery of materials to Designated Post-Collection Service Provider that contain more than the percentage by weight of Non-PPP Items for a given contract year.

4 Failure to enact its applicable Business Continuity Plan, on the occurrence of a Labour Disruption.

5 Contractor delivers In-Scope PPP to any location other than the Designated Post-Collection Service Provider without prior written permission.

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APPENDIX D - PROGRAM AGREEMENT BETWEEN STEWARDSHIP ONTARIO AND THE AUTHORITY

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#CycleON: Action Plan 2.0, EBR Posting No. 013-1837

RECOMMENDATIONS 1. That County Council endorse the Oxford County Submission in response to EBR

Posting No. 013-1837 regarding the proposed #CycleON: Action Plan 2.0 as outlined in Report No. PW 2018-12;

2. And further, that Report No. PW 2018-12 be circulated to Area Municipalities for

information.

REPORT HIGHLIGHTS The Ontario Ministry of Transportation (MTO) and the Ontario Ministry of Tourism, Culture,

and Sport (MTCS) are developing the next multi-year action plan to advance the implementation of #CycleON: Ontario’s Cycling Strategy and are undertaking public consultation on the proposed Action Plan 2.0.

This report seeks to inform County Council of the consultation process and the comments submitted by staff to the MTO on March 7, 2018, which supported the proposed initiatives around infrastructure enhancements to cyclist safety and improvements to cycling network connectivity.

Implementation Points Following Council authorization, a copy of the Council resolution will be forwarded to the Ministry of Transportation and the report will be circulated to our Area Municipalities.

Financial Impact The recommendations within this report will have no financial impact. The Treasurer has reviewed this report and agrees with the financial impact information.

Report No: PW 2018-12 PUBLIC WORKS

Council Date: April 11, 2018

Page 2 of 4

Risks/Implications There are no risks or implications associated with this report.


1. i. A County that Works Together – Strengthen, diversify and broaden the economic/prosperity base through:

- Strengthening tourism-supportive initiatives

1. ii. A County that Works Together – Enhance the quality of life for all of our citizens by:

- Working with community partners and organizations to maintain / strengthen public safety

- Promoting community participation and life-long involvement in recreational and cultural activities

2. i. A County that is Well Connected – Improve travel options beyond the personal vehicle by:

- Creating, enhancing and promoting the use of an integrated trail and bike path system - Promoting active transportation

2. ii. A County that is Well Connected – Advocate for appropriate federal and provincial support, programming and financial initiatives to strengthen the movement of people and goods to, from and through the County

3. ii. A County that Thinks Ahead and Wisely Shapes the Future – Implement development policies, land uses and community planning guidelines that:

- Provides a policy framework which supports community sustainability, health and well-being

- Supports healthy communities within the built environment

- Providing multiple opportunities for public participation and a meaningful voice in civic affairs

- Fostering greater involvement in County and community events and/or program/project implementation

- Understanding and addressing public aspirations for a more livable community



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DISCUSSION

Background In support of the expansion of cycling initiatives in the province, Ontario established #CycleON: Ontario’s Cycling Strategy in 2013. Action Plan 1.0 was implemented by the Province in 2014 as the first in a series of action plans to address the following five strategic directions identified in the strategy:

1. Design Healthy, Active and Prosperous Communities 2. Improve Cycling Infrastructure 3. Make Highways and Streets Safer 4. Promote Cycling Awareness and Behavioural Shifts 5. Increase Cycling Tourism Opportunities

Action Plan 2.0 will be the second wave of action plans to implement the provincial cycling strategy.

Comments The Oxford County comments (Attachment 1) were submitted to the MTO on March 7, 2018 and were presented to the Oxford County Cycling Advisory Committee (CAC) at its regular meeting on March 12, 2018. Staff support the proposed initiatives in Action Plan 2.0 which are intended to enhance safety for cyclists and motorists through improved cycling infrastructure, education, promotion, behavioural shifts and bicycle friendly community planning that will ultimately promote cycling as an increasing alternate mode of transportation. Implementation of the Province-wide cycling network combined with secondary destination-oriented routes, will promote recreational cycling and advance tourism opportunities locally and throughout Ontario. The County’s comments suggest that the Province should consider investment specifically for providing paved shoulders on rural roads and highways to provide connectivity between communities and places of interest where, in most cases, cycling and trail networks are already in place.



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Conclusions The provincial cycling initiatives align with the County’s goals and objectives to reduce greenhouse gas emissions through promotion of low carbon transportation and the 100% renewable energy target. Council’s endorsement of the Oxford County submission will support these initiatives.

SIGNATURES

Report Author: Original signed by: Frank Gross, C. Tech Manager of Transportation and Waste Management Services

Departmental Approval: Original signed by: David Simpson. P. Eng., PMP Director of Public Works



ATTACHMENT Attachment 1: Oxford County Response to EBR Registration No. 013-1837

#CycleON: Action Plan 2.0 EBR Posting # 013-1837

____________________________________________________________________________________

Overview

The Province has developed a proposal outlining actions under consideration for Action Plan 2.0, the second implementation for #Cycle ON: Ontario’s Cycling Strategy. Action Plan 2.0 is intended to build upon the significant advancements in cycling infrastructure and legislation established in Action Plan 1.0. The action items outlined in the proposal are intended to help Ontario address the five Strategic Directions of #CycleON:

1. Design Healthy, Active and Prosperous Communities2. Improve Cycling Infrastructure3. Make Highways and Streets Safer4. Promote Cycling Awareness and Behavioural Shifts5. Increase Cycling Tourism Opportunities

Background

Oxford County is located in Southwestern Ontario and is governed by a two-tier system comprised of eight (8) area municipalities. The County owns and maintains the County Road network, which consists of 640 kilometers (centerline) of roads.

Oxford County is the first municipality in Ontario to commit to a 100% renewable energy target (2050) and has adopted a Community Sustainability Plan with targets to reduce greenhouse gas emissions and actions to promote low-carbon transportation.

In 2012, County Council adopted the cycling chapter as part of the Transportation Master Plan (TMP). The objectives of the County’s cycling initiatives are to enhance safety for both motorists and cyclists, and provide connectivity to communities and local cycling networks. The cycling chapter in the TMP includes the following key initiatives:

• Continue to provide wider asphalt surface with an edge line during road resurfacing projects;• Installation of ‘Share the Road’ signs;• Consideration of cycling facilities in future Class Environmental Assessment Studies; and• Facilitation of a Cycling Advisory Committee

The County is currently in the process of updating the TMP and will also undertake a Cycling Master Plan in 2018 to further advance cycling initiatives.

The County is also participating in the Ontario Municipal Commuter Cycling Program and has partnered with the Town of Ingersoll to construct a separated multi-use path that is intended to promote commuter cycling.

www.oxfordcounty.ca


EBR Posting #013-1837

Comments Safety for cyclists and motorists is a common objective in local and provincial cycling initiatives. Ontario’s Cycling Strategy has identified that 78% of Ontarians believe more people would cycle if there was better cycling infrastructure which reduced safety concerns and increased the overall comfort level for the majority of people. Improvements to cycling infrastructure, education, promotion, behavioural shifts, and bicycle friendly community planning will enhance safety and ultimately promote cycling as an increasing alternate mode of transportation. Implementation of the Province-wide cycling network and provincial support to help municipalities develop portions of the network within their jurisdiction, combined with secondary destination-oriented routes, will promote recreational cycling and increase tourism opportunities locally and throughout Ontario. Establishing designated cycling routes will improve safety for both cyclists and motorists and help to prioritize cycling infrastructure improvements. Further to that, the Province should consider investment specifically for providing paved shoulders on rural roads and highways that will provide connectivity between communities and places of interest where, in most cases, cycling and trail networks are already in place. The initiatives identified in #CycleON: Action Plan 2.0 will help to achieve Ontario’s goals for cycling. The provincial cycling initiatives align with County’s goals and objectives to reduce greenhouse gas emissions through promotion of low carbon transportation and the 100% renewable energy target, as well as promoting cycling for recreation, tourism and community wellbeing. The County is looking forward to working with the Province and implementation of the #CycleON Action 2.0. Plan.

___________________________________________________________________________________

Prepared for: Katerina Minaeva Senior Policy Analyst Ministry of Transportation Further Information: Frank Gross Manager of Transportation/Waste ([email protected]) Melissa Abercrombie Manager of Engineering Services ([email protected]) Meredith Maywood Tourism Specialist-Tourism Oxford ([email protected])

www.oxfordcounty.ca






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Northeast Woodstock Trunk Sewer Downstream Upgrades, 2018 Construction Contract

RECOMMENDATIONS 1. That County Council award a contract to the low bidder, Omega Contractors Inc.,

in the amount of $2,595,861 (excluding HST), for the Northeast Woodstock Trunk Sewer Downstream Upgrades 2018 Construction Contract;

2. And further, that Council authorize the Chief Administrative Officer and Director of Public Works to sign all documents related thereto.

REPORT HIGHLIGHTS The purpose of this report is to obtain County Council approval to award a contract for the

Northeast Woodstock Trunk Sewer Downstream Upgrades 2018 Construction Contract.

This work is being undertaken to increase the capacity of the existing trunk sewer in order to accommodate the increase in sewage flow demands that will be required from future development. This project is anticipated to start in May 2018 and be completed by end of August 2018.

Implementation Points Upon approval of the recommendations contained in this report, a contract for the above noted project will be executed with the successful contractor and a work plan will be confirmed prior to proceeding with the work.

Financial Impact The approved 2018 budget for the Northeast Woodstock Truck Sewer Downstream Upgrades project is $5,314,000 (including trunk sewer removal, replacement and restoration). The funding sources for this project include $0.5 million from development charges and $4.8 million from the Woodstock Wastewater reserve. The project costs are summarized in Table 1 below.



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Table 1 Funding for Northeast Woodstock Trunk Sewer Downstream Upgrades

950141 – 2018 Northeast Woodstock Trunk Sewer Downstream Upgrades

Description Amount

Omega Contractors Inc. Low Bid (excl. HST) $2,595,861

Non-Refundable HST (1.76%) $45,688

Contract Administration and Materials Testing (~7%) $182,000

Estimated Total Project Cost $2,823,549

The Treasurer has reviewed this report and agrees with the above noted financial impact information.

Risks/Implications This project has the potential risks that would be associated with any construction project. Construction bonds and insurance are required by the contractor to mitigate risks related to the exposure of financial loss. Communication with adjacent businesses and property owners has commenced and further communication is planned prior to, and during construction. This project consists of replacing an existing trunk sanitary sewer. In general, this work will not negatively impact the surrounding environment and will not change existing site conditions. Permission has been received from the Upper Thames River Conservation Authority (UTRCA) to undertake the work. Ongoing discussions prior to, during and after the work, will continue with the UTRCA.



- Maintaining and strengthening core infrastructure.

DISCUSSION

Background The Northeast Woodstock Trunk Sewer (also referred to as Roth Park Trunk Sewer) extends from Lansdowne Avenue in the east and runs westward adjacent to and south of Pittock Reservoir and the Thames River until it crosses the Canadian Pacific Railway (CPR) and turns south, traversing private property along Tecumseh Street and finally conveying flows to the Woodstock Wastewater Treatment Plant (WWTP). The length of the trunk sewer is



Page 3 of 4

approximately 4,500 m and ranges in diameter from 300 mm to 1500 mm. Catchments consisting of residential, commercial, and industrial land use contribute flows to the sewer. In 2013, Oxford County Public Works retained an engineering consultant (AECOM) to undertake a hydraulic modelling assessment of the Northeast Woodstock Trunk Sewer in order to assess the current sewer capacity and its ability to meet future wastewater flow estimates. Based on the results of hydraulic modeling, there were two (2) sections of the trunk sewer that require upsizing in order to accommodate increased estimated flows associated with future development. These two sections are being identified as: (1) the upstream portion (sewer extending from Lansdowne Avenue to Donald Thompson Park) and (2) the downstream portion (sewer extending from the Jack Poole overflow structure to the lower overflow structure at the Woodstock WWTP). As shown in Attachment 1, the work covered under this contract will consist of upsizing the downstream trunk sewer portion only (from MH200 to MH220). Additional work will include abandonment of the existing trunk sewer alignment (located on private property) and relocating the trunk sewer within Tecumseh Street right-of-way. Relocating the sewer to public right-of-way will improve accessibility for staff to operate or maintain the sewer and eliminate the undesirable need for maintaining easement agreements with multiple private property owners. County staff have discussed the proposed reconstruction work with City of Woodstock staff. Inputs from City staff have been considered in the design of the project. Prior to construction, a public meeting will be held to review the proposed work with residents and businesses.

Comments

Tender submissions for this capital project were received and opened after the tender closed at 10:00 am on March 19, 2018 as shown in Table 2 below.

Table 2 Tender Submissions Received for Northeast Woodstock Trunk Sewer (Downstream) Upgrades

CONTRACTOR BID AMOUNT

(HST Included)

Omega Contractors Inc. $2,933,322.79

Blue-Con Construction $2,986,583.23

Oxford Civil Group Inc. $3,203,462.14

Network Sewer and Watermain Ltd $3,433,740.16

Birnam Excavating Ltd. $3,515,254.71

Sierra Infrastructure Inc $3,689,924.88

Elgin Construction $4,210,075.73

Staff have reviewed the submissions and confirmed that the low bid received from Omega Contractors Inc. represents good value for the work. This project is anticipated to start in May 2018 and be completed by end of August 2018.



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Additional improvements to the Northeast Woodstock Trunk Sewer are planned for the upstream portion of the sewer. The upstream portion improvements are currently under design and will involve further public consultation prior to the final design, tendering and construction.

Conclusion Staff review of the bid submissions have confirmed that it is appropriate to award a contract to undertake this work.

SIGNATURES

Report Author: Original signed by:

Reuben Davis, P.Eng. Project Engineer

Departmental Approval:

Original signed by: David Simpson, P.Eng., PMP Director of Public Works



ATTACHMENT Attachment 1: Northeast Woodstock Trunk Sewer Upgrades 2018 Construction

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WOODSTOCK WWTP

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Oxford Road 3 Emergency Repairs

RECOMMENDATIONS 1. That County Council receive report No PW 2018-14 titled “Oxford Road 3

Emergency Repairs” for information;

2. And further, that County Council authorize the transfer of funds from the Roads Reserves, in the amount of $42,000, to finance expenditures for emergency repairs on Oxford Road 3.

REPORT HIGHLIGHTS The purpose of this report is to provide County Council with information regarding a flood

event that occurred during the week of February 19, 2018, which resulted in impacts to several area roadways.

Part of Oxford Road 3, from Township Road 10 to Township Road 12 in Blandford-Blenheim Township, was closed from February 22nd to March 1st, 2018 due to this flooding and subsequent flood damage.

Emergency road repairs were completed by Road Operations staff, with the assistance of an external Contractor, for a total cost of $42,000.

Financial Impact The road restoration work was completed as an Emergency Purchase in accordance with Section 10.1 of the Purchasing Policy. With the approval of this report, the expenditures incurred will be funded from the Roads Reserve with a budgeted 2018 closing balance of $5,370,147. Emergency road repair costs are summarized below:



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Item Cost

Salaries & Benefits $12,000

External Contractor (labour, equipment, culvert pipe)

$12,000

Materials (road base and shoulder aggregate)

$18,000

TOTAL COST $42,000

The Treasurer has reviewed the report and agrees with the financial impact information.

Risks/Implications There are no risks or implications associated with this report.



- Maintaining and strengthening core infrastructure

DISCUSSION

Background During the week of February 19, 2018, heavy rain, mild temperatures, and rapid melting of snow pack caused localized flooding, leading to impacts to several area roadways. During this same period, extensive flooding also occurred in Brantford, where a state of emergency was declared, as well as in London and south Cambridge.



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Area roadways impacted by this flooding included several Oxford County roads at the following locations:

Oxford Road 2: West end Woodstock at the Thames River

Oxford Road 3: North of Drumbo at the Nith River

Oxford Road 6: South of the 401

Oxford Road 19: Between Oxford Road 13 and Middletown Line

Oxford Road 22: Between Oxford Road 29 and Oxford Road 8

Road closures were established in the affected areas and remained in effect until water receded and staff were able to assess the extent and severity of damage. In most locations, flood damage was minimal and the affected roads were reopened within one to two days.

However, the flood damage along Oxford Road 3, from Township Road 10 to Township Road 12 in Blandford-Blenheim Township, was more extensive and required emergency repairs before it could be reopened to traffic.

Comments

The section of Oxford Road 3 in Blandford-Blenheim Township that was impacted by flooding was closed from February 22, 2018 to March 1 2018. The flood damage included a culvert washout and significant erosion of the roadside shoulders with undermining of the asphalt surface. The affected areas extended from Township Road 10 to Township Road 12 and are shown on the map in Attachment 1. Photographs of the flood damage are included in Attachment 2.

The necessary road repairs involved the following work activities:

Asphalt removal to delineate the extent of road surface undermining.

Restoration of the granular road base and roadside shoulders.

Culvert removal and replacement.

Asphalt restoration.

Road repairs were completed by Road Operations staff with the assistance of an external Contractor. The existing culvert where the washout occurred was replaced with a new pipe, and the addition of a second pipe, to increase future drainage capacity. The road base and shoulders were restored with imported granular material and the asphalt was temporarily restored with asphalt millings from the County’s stockpile.

Oxford Road 3, through the flood impacted area, is coincidently scheduled for asphalt resurfacing under the 2018 approved County-wide resurfacing program, therefore, no additional work is required for final asphalt restoration of the repaired areas.



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Conclusions

Flood damage to part of Oxford Road 3 compromised the structural integrity of the road and required emergency repairs before it could be reopened.

Road Operations staff completed the work efficiently and cost effectively through the use of internal resources (equipment, materials) and external services, as well as, minimized the duration of the road closure to one week.

SIGNATURES

Report Author:

Original signed by:

Frank Gross, C. Tech Manager of Transportation and Waste Management Services

Departmental Approval:

Original signed by:

David Simpson. P. Eng., PMP Director of Public Works

Approved for submission:

Original signed by:


ATTACHMENTS

Attachment 1: Map - Oxford Road 3 Flood Damage and Emergency Repairs Attachment 2: Photographs – Oxford Road 3 Flood Damage and Emergency Repairs

N

Township Road 12

Oxford Road 3 Flood Damage and Emergency Repairs

Township Road 10

CLOSURE

CLOSURE

Township Road 12

Township Road 10

Township Road 11

Surface undermining& loss of shoulder

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Oxford Road 3

CulvertWashout


Attachment 2 to PW 2018-14 April 11, 2018

1

Oxford Road 3 Flood Damage and Emergency Repairs

Photo 1 – Loss of Shoulder Material and Undermining of Asphalt Surface

Photo 2 – Washout at Culvert just North of Blandford-Blenheim Township, Road 10

Attachment 1 to PW 2018-14 April 11, 2018

2

Photos 3 and 4 – Culvert Replacement and Road Restoration at Washout

Photo 5 – Shoulder and Asphalt Restoration

Briefing Note CS 2018-03 CORPORATE SERVICES


2018 Tax Policy – Supplementary Information – Farm Tax Ratio Reduction Scenarios Overview Supplementary information to Report No. CS 2018-06, dated March 14, 2018 and Report No. CS

2018-08, dated March 28, 2018

Key points Table 1 - Levy distribution scenarios presented in dollar value by class

Scenarios include 0.215 and increase by increments of 0.005 up to 0.25

Scenarios illustrate dollar value change from 2017 as the base year

Table 2 - Levy distribution scenarios presented by percentage allocation of the levy

Scenarios include 0.215 and increase by increments of 0.005 up to 0.25

Scenarios illustrate percentage change from 2017 as the base year

Table 3 – Tax impact on average and typical properties by class

All scenarios attached to this report reflect the multi-residential tax ratio reduction to 2.37, consistent with all scenarios presented for 2018 tax policy analysis

Background Report No. CS 2018-06 – 2018 Tax Policy, dated March 14, 2018

Staff direction to provide further analysis that illustrates the distribution of the tax levy on all property classes that would result in the farm class ratio to 0.21 and 0.22 and how it compares with levy distributions in 2017

Report No. CS 2018-08 – 2018 Tax Policy Review, dated March 28, 2018

Motion to reduce farm tax ratio to 0.21 failed

Recommendation contained in Report No. CS 2018-08 was deferred to next regular meeting of Council

Respectfully Submitted by: Lynn S. Buchner, CPA, CGA, Director of Corporate Services Approved for Submission by: Peter M. Crockett, P.Eng., Chief Administrative Officer Attachments (2)

Table 1 – Levy Distribution – Scenarios – Farm Ratios Compared to 0.25 - by Dollar Value

Municipal General LevyProperty Tax Class 2017 2018 2018 2018 2018 2018 2018 2018 2018Farm Ratio 0.25 0.25 0.245 0.24 0.235 0.23 0.225 0.22 0.215Residential $35,558,014 $36,041,166 $36,098,612 $36,156,265 $36,214,075 $36,272,046 $36,330,233 $36,388,570 $36,447,168Farm 3,927,535 4,460,818 4,378,587 4,296,061 4,213,290 4,130,272 4,046,959 3,963,401 3,879,547Managed Forest 8,835 9,566 9,581 9,596 9,611 9,627 9,642 9,658 9,673Multi-Residential 1,734,422 1,649,679 1,652,308 1,654,946 1,657,592 1,660,247 1,662,912 1,665,586 1,668,264Commercial 7,114,414 7,195,675 6,675,503 6,688,885 7,182,317 6,707,581 7,253,387 7,265,057 6,742,718Industrial 2,029,507 2,046,774 2,667,810 2,674,868 1,825,693 2,680,629 2,063,190 2,066,506 2,693,571Large Industrial 3,611,233 3,535,378 3,454,867 3,454,852 3,831,095 3,471,467 3,563,733 3,569,461 3,485,477Pipeline 1,136,180 1,121,851 1,123,639 1,125,434 1,127,234 1,129,038 1,130,851 1,132,668 1,134,489Taxable Total $55,120,140 $56,060,907 $56,060,907 $56,060,907 $56,060,907 $56,060,907 $56,060,907 $56,060,907 $56,060,907

$533,283 $451,052 $368,526 $285,755 $202,737 $119,424 $35,866 -$47,988

Table 2 – Levy Distribution – Scenarios – Farm Ratios Compared to 0.25 - by Percentage

Municipal General LevyProperty Tax Class 2017 2018 2018 2018 2018 2018 2018 2018 2018Farm Ratio 0.25 0.25 0.245 0.24 0.235 0.23 0.225 0.22 0.215Residential 64.51% 64.29% 64.39% 64.49% 64.60% 64.70% 64.80% 64.91% 65.01%Farm 7.13% 7.96% 7.81% 7.66% 7.52% 7.37% 7.22% 7.07% 6.92%Managed Forest 0.02% 0.02% 0.02% 0.02% 0.02% 0.02% 0.02% 0.02% 0.02%Multi-Residential 3.15% 2.94% 2.95% 2.95% 2.96% 2.96% 2.97% 2.97% 2.98%Commercial 12.91% 12.84% 11.91% 11.93% 12.81% 11.96% 12.94% 12.96% 12.03%Industrial 3.68% 3.65% 4.76% 4.77% 3.26% 4.78% 3.68% 3.69% 4.80%Large Industrial 6.55% 6.31% 6.16% 6.16% 6.83% 6.19% 6.36% 6.37% 6.22%Pipeline 2.06% 2.00% 2.00% 2.01% 2.01% 2.01% 2.02% 2.02% 2.02%Taxable Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

0.83% 0.69% 0.54% 0.39% 0.24% 0.09% -0.06% -0.21%

Change in Farm Portion from 2017

Change in Farm Portion from 2017

Briefing Note No. CS 2018-03 Attachment No. 1

Table 3 – Tax Impact on Average Residential Property and Typical (Median) Farm and Business Properties

2017Actual

Single family dwelling $252,119 $257,034 $257,034 $257,034 $257,034 $257,034 $257,034 $257,034 $257,034 General tax $954 $933 $934 $936 $937 $939 $940 $942 $943Change from 2017 -$21 -$20 -$18 -$17 -$15 -$14 -$12 -$11

Farm House $164,375 $173,950 $173,950 $173,950 $173,950 $173,950 $173,950 $173,950 $173,950 General tax $622 $631 $632 $633 $634 $635 $636 $637 $638Change from 2017 $9 $10 $11 $12 $13 $14 $15 $16

Farm Land $882,800 $1,041,300 $1,041,300 $1,041,300 $1,041,300 $1,041,300 $1,041,300 $1,041,300 $1,041,300 General tax $835 $944 $927 $910 $892 $874 $857 $839 $821Change from 2017 $110 $92 $75 $57 $40 $22 $4 -$14

Industrial - standard property $988,750 $1,000,500 $1,000,500 $1,000,500 $1,000,500 $1,000,500 $1,000,500 $1,000,500 $1,000,500 General tax $9,838 $9,547 $9,562 $9,577 $9,592 $9,608 $9,623 $9,639 $9,654Change from 2017 -$291 -$276 -$261 -$246 -$230 -$215 -$199 -$184

Commercial - small office building $194,250 $194,500 $194,500 $194,500 $194,500 $194,500 $194,500 $194,500 $194,500 General tax $1,398 $1,342 $1,344 $1,346 $1,348 $1,351 $1,353 $1,355 $1,357Change from 2017 -$56 -$53 -$51 -$49 -$47 -$45 -$43 -$40

Notes:1. All scenarios reflect multi-residential ratio reduction to 2.372. Residential property class values are based on average within that class filtered to remove vacant lots and properties with water fronts3. Farm and business property class values are based on median or typical property in each class having an assessed value at or near the midpoint or median for the class and a per cent change in assessment for the year at or near the median for the class

2018 Farm 0.22

2018 Farm 0.215

2018 Farm 0.23

2018 Farm 0.225

2018 Farm 0.24

Business Property Classes

2018 Farm 0.235

2018 Farm 0.245

2018 Farm 0.25Residential

Farm Related Properties

Briefing Note No. CS 2018-03 Attachment No. 2


CORPORATE SERVICES Council Date: March 28, 2018


From: Director of Corporate Services

2018 Tax Policy Review RECOMMENDATION 1. That the necessary by-laws addressing the following tax policy matters be

prepared on the basis of staff direction received in response to the analysis contained in Report No. CS 2018-08, entitled “Tax Policy Review”, for Council’s consideration at the April 11, 2018 Council meeting:

a. Tax Ratios; b. Tax Rate Reductions for Prescribed Property Subclasses; c. Tax Rates for Upper Tier Purposes; d. Capping Calculation Options; e. Lower Limit for Applying Tax to New Construction Properties.

REPORT HIGHLIGHTS Review tax policy recommendations proposed for 2018 prior to passing the required by-laws

2018 Tax Policy recommendations highlights include:

Present various scenarios of employing the available tax policy tools that offer a fair and equitable distribution of County and area municipal levies among the property tax classes Continue reduction of the multi-residential property class tax ratio to the

revised maximum threshold ratio of 2.0, phased-in over a period of four years Utilizing all tax capping tools available to expedite opting out of the business property

class tax capping regime

Implementation Points Subject to Council approval, tax policy by-laws will be prepared on the basis of the recommendations contained in Report No. CS 2018-06 and any further direction received in response to the analysis and recommendations in Report No. CS 2018-08. In order for Area Municipalities to proceed with final tax bills on schedule with previous years, the tax policy by-laws will be presented to Council for consideration at their April 11, 2018 meeting.

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Financial Impact No financial impacts will result from adopting the recommendation contained in this report beyond what has already been approved in the current year’s budget.

The Treasurer has prepared this report in consultation with the Area Municipal Treasurers and Tax Collectors.

Risks/Implications There are no risks or implications that will result by adopting the recommendation contained in this report. However, irrespective of the fact that the statutory deadline for enacting tax policy by-laws is December 31st, consideration should be given to making these decisions in a timely manner to allow final tax billing to occur so all municipalities within the County will be able to maintain the necessary cashflow to continue with business operations and capital works. Strategic Plan (2015-2018) County Council adopted the County of Oxford Strategic Plan (2015-2018) at its regular meeting held May 27, 2015. The initiative contained within this report supports the Values and Strategic Directions as set out in the Strategic Plan as it pertains to the following Strategic Directions: 3. iii. A County that Thinks Ahead and Wisely Shapes the Future - Demonstrated commitment to

sustainability by:


o Life cycle costs and benefit/costs, including debt, tax and reserve levels and implications

DISCUSSION Background Tax policy recommendations contained in Report No. CS 2018-06 were presented to Council at their March 14, 2018 meeting. The recommendations were formed based on collaborative perspectives of each of the Area Municipal Treasurers and/or Tax Collectors having regard for local impacts.

Highlights of the recommendations contained in Report No. CS 2018-06 are included in Table 1.

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Table 1 – 2018 Tax Policy Recommendations

Decision Points Recommendation

1. Optional property classes – multi-residential, office buildings, shopping centres, parking lots Sub-class commercial and industrial on farm properties

None recommended - except maintain large industrial class New sub-class for small-scale on-farm business – not recommended for 2018

2. Tax rate discounts – for vacant lands and farmland awaiting development Currently Farm 55% Commercial 30% Industrial 35%

No change recommended

3. Maximum tax protection mechanism Fund capping costs through the current year’s budget as general taxation, netted against supplementary taxes and write-offs

4. Tax ratios Reduce multi-residential tax ratio to 2.37 to continue the four-year reduction started in 2017 to arrive at 2.0, to meet the newly prescribed provincial threshold, by the end of the current assessment cycle

Decision Points Recommendation

5. Graduated tax rates – two or three thresholds for each band

Not recommended

6. Capping calculation options Recommend employing all available tools to opt-out of capping program for multi-residential, commercial and industrial classes

7. Lower limit for new construction projects

Lower limit set at 100% for starting tax levels for new construction properties that become eligible within the taxation year

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Comments In response to the recommendations contained in Report No. CS 2018-06, at their meeting held March 14, 2018, County Council gave staff direction to provide further analysis that illustrates the distribution of the tax levy on all property classes that would result by reducing the farm class ratio to 0.21 and 0.22 and how it compares with the levy distributions in 2017. In addition, staff were asked to poll other upper/single-tier rural municipalities to determine the farm tax ratios they have adopted for 2018; provide three year comparators of the County’s assessment, growth and distribution of the tax levy, by property class; and, progression of the phased CVA increases applicable to the 2017 – 2020 assessment cycle.

The following sections of this report and its attachment provides the detailed information requested. 2017 – 2020 Current Assessment Cycle Progression of Phased CVA Attachment No. 1 to this report is and excerpt from the Preliminary Reassessment Impact Study -Notice Based Data Version, prepared by Municipal Tax Equity (MTE) Consultants Inc., dated November 4, 2016. It illustrates the realization of properties’ full CVA values over the four-year assessment cycle, by property class. The Table begins by presenting the January 1, 2012 full CVA and the migration over the next four years to reach the January 1, 2016 CVA destination value. Assessment and Revenue Growth At the time the 2018 Province of Ontario property assessment roll was delivered, MPAC announced that the new roll represented the largest assessment growth they have ever recorded, largely attributable to property development in residential and business sectors. Similarly, Oxford County experienced exceptional growth in 2017 within those same property classes. Tables 2 and 3 illustrate a three year comparison of the County’s assessment and annualized revenue growth by property class. Table 2 – Assessment Growth for Years 2015 to 2017

Property Tax Class $ % $ % $ % Residential 73,316,147 0.82% 148,313,896 1.64% 293,641,419 2.90% Farm 76,976,300 2.30% 58,020,500 1.72% 25,722,131 0.40% Managed Forest 863,400 11.07% 133,200 1.60% 336,700 2.79% Multi-residential 3,209,640 1.61% -4,220,000 -2.09% 5,396,800 2.77% Commercial 13,004,860 1.33% 2,812,796 0.28% 12,333,321 1.10% Industrial 98,555 0.05% 473,636 0.22% 5,383,166 2.39% Large Industrial -830,000 -0.22% -2,070,300 -0.55% -4,265,100 -1.05% Pipeline 564,000 0.24% 554,000 0.24% 581,000 0.23% Sub-total Taxable 167,202,902 1.17% 204,017,728 1.41% 339,129,437 1.81%

20172015 2016

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aferrell

Underline



Table 3 – Revenue Growth for Years 2015 to 2017

In summary, these two tables demonstrate that when ratios remain static, with the exception of the multi-residential ratio, the change in assessment and growth among property classes remains relatively consistent. It is evident by Table 3 that the pace of growth significantly increased in 2017 for the residential and business classes, by more than double overall compared to the past two years. Tax Levy Comparisons The following table depicts how the County’s general tax levy has changed over the past three years and how it has been shared among the property classes. The distribution of the tax levy between property classes is driven by unique ratios for each class relative to the residential class, which is set at one. Table 4 – County General Levy Distribution for Years 2015 to 2017

The levy distributions among classes have remained fairly flat over the three year period, with the exception of the multi-residential class which responded to a reduction in the ratio in 2017, causing an opposing increase in the residential allocation.

Property Tax Class $ % $ % $ % Residential 282,907 0.84% 559,275 1.64% 1,127,911 3.17% Farm 68,088 2.30% 54,704 1.72% 16,592 0.42% Managed Forest 788 10.97% 126 1.60% 271 3.07% Multi-residential 31,217 1.59% -48,713 -2.33% 38,551 2.22% Commercial 95,052 1.36% 18,636 0.26% 113,683 1.60% Industrial 6,792 0.33% 333 0.02% 61,812 3.05% Large Industrial -8,015 -0.23% -19,405 -0.53% -39,215 -1.09% Pipeline 2,685 0.24% 2,630 0.24% 2,539 0.22% Sub-total Taxable 479,513 0.92% 567,586 1.07% 1,322,144 2.40%

2015 2016 2017

Property Tax Class $ % $ % $ % Residential 33,625,417 64.38% 34,178,985 64.17% 35,558,014 64.51% Farm 2,957,395 5.66% 3,181,470 5.97% 3,927,535 7.13% Managed Forest 7,176 0.01% 7,829 0.01% 8,835 0.02% Multi-residential 1,964,176 3.76% 2,089,519 3.92% 1,734,422 3.15% Commercial 6,985,388 13.37% 7,041,814 13.22% 7,114,414 12.91% Industrial 2,048,438 3.92% 1,850,487 3.47% 2,029,507 3.68% Large Industrial 3,541,461 6.78% 3,817,124 7.17% 3,611,233 6.55% Pipeline 1,097,807 2.10% 1,099,039 2.06% 1,136,180 2.06% Sub-total Taxable 52,227,258 100.00% 53,266,267 100.00% 55,120,140 100.00%

2015 2016 2017

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Farm Tax Ratio Scenarios Table 5 presents analysis on two additional farm ratio scenarios as directed by Council. It illustrates the tax distribution among all property classes that would result by reducing the farm ratio from 0.25 to 0.22 and 0.21 respectively. This Table also identifies the respective change of each of the scenarios in terms of levy distribution to the farm class from 2017, which was based on a ratio of 0.25. Table 5 – Levy Distribution – Scenarios – Farm Ratio 0.22 and 0.21 Compared to 0.25

Table 6 illustrates the three farm tax ratio scenarios for 2018 that are presented in Table 5 as percentage of levy allocation among the property classes as opposed to dollar value. Table 6 – % Share of Levy Distribution Based on Three Farm Ratio Scenarios

Municipal General LevyProperty Tax Class 2017 2018 2018 2018Farm Ratio 0.25 0.25 0.22 0.21Residential $35,558,014 $36,041,166 $36,388,570 $36,505,925Farm 3,927,535 4,460,818 3,963,401 3,795,398Managed Forest 8,835 9,566 9,658 9,689Multi-Residential 1,734,422 1,649,679 1,665,586 1,670,956Commercial 7,114,414 7,195,675 7,265,057 7,288,480Industrial 2,029,507 2,046,774 2,066,506 2,073,169Large Industrial 3,611,233 3,535,378 3,569,461 3,580,969Pipeline 1,136,180 1,121,851 1,132,668 1,136,321Taxable Total $55,120,140 $56,060,907 $56,060,907 $56,060,907

$483,152 $35,866 -$132,137Change in Farm Portion from 2017

Municipal General LevyProperty Tax Class 2017 2018 2018 2018Farm Ratio 0.25 0.25 0.22 0.21Residential 64.51% 64.29% 64.91% 65.12%Farm 7.13% 7.96% 7.07% 6.77%Managed Forest 0.02% 0.02% 0.02% 0.02%Multi-Residential 3.15% 2.94% 2.97% 2.98%Commercial 12.91% 12.84% 12.96% 13.00%Industrial 3.68% 3.65% 3.69% 3.70%Large Industrial 6.55% 6.31% 6.37% 6.39%Pipeline 2.06% 2.00% 2.02% 2.03%Taxable Total 100.0% 100.0% 100.0% 100.0%

0.83% -0.06% -0.36%Change in Farm Portion from 2017

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Impact on Typical Properties – Farm Ratio Scenarios The Tables presented under this section of the report illustrate the impact on the typical residential property for each of the three farm ratio scenarios. Due to the fact that such a large proportion of farm properties are made up of multiple portions (residential, commercial, etc.), the impact on farm related properties is based on the median CVA for a farm house and for farm land per roll number. This is prepared for illustrative purposes only as assessment per roll as it relates to farmland and is not necessarily reflective of an entire farming operation. Table 7 – Impact on Typical Residential Properties – Farm Ratio 0.25

Table 8 – Impact on Typical Farm Related Properties – Farm Ratio 0.25

2017 2018Actual Preliminary

Phased CVA $252,119 $257,034 $4,915 1.95% General tax rate 0.00378327 0.00362809 -0.00015518 -4.10% General tax $954 $933 -$21 -2.23%


Phased CVA $200,000 $200,000 $0 0.00% General tax rate 0.00378327 0.00362809 -0.00015518 -4.10%General tax $757 $726 -$31 -4.10%

Single Family Detached Residential

$ Change % Change

Single Family Detached Residential

$ Change % Change

Farm Related Properties 2017 2018 $ Change % ChangeActual Preliminary

Farm House CVA $164,375 $173,950 $9,575 5.83% General tax rate 0.00378327 0.00362809 -0.00015518 -4.10% General tax $622 $631 $9 1.48%Farm Related Properties 2017 2018 $ Change % Change

Actual PreliminaryFarm Land CVA $882,800 $1,041,300 $158,500 17.95% General tax rate 0.00094582 0.00090702 -0.00003880 -4.10% General tax $835 $944 $110 13.12%

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Table 9 – Impact on Typical Residential Properties – Farm Ratio 0.22


Table 11 – Impact on Typical Residential Properties – Farm Ratio 0.21


Phased CVA $252,119 $257,034 $4,915 1.95% General tax rate 0.00378327 0.00366307 -0.00012020 -3.18%General tax $954 $942 -$12 -1.29%


Phased CVA $200,000 $200,000 $0 0.00% General tax rate 0.00378327 0.00366307 -0.00012020 -3.18% General tax $757 $733 -$24 -3.18%

Single Family Detached Residential $ Change % Change




Actual PreliminaryFarm Land CVA $882,800 $1,041,300 $158,500 17.95% General tax rate 0.00094582 0.00080588 -0.00013994 -14.80% General tax $835 $839 $4 0.50%


Phased CVA $252,119 $257,034 $4,915 1.95% General tax rate 0.00378327 0.00367488 -0.00010839 -2.86% General tax rate $954 $945 -$9 -0.97%


Phased CVA $200,000 $200,000 $0 0.00% General tax rate 0.00378327 0.00367488 -0.00010839 -2.86% General tax rate $757 $735 -$22 -2.86%



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It is important to understand that in determining farmland values for properties that are farmed by the owner and/or tenant are valued based farmer-to-farmer sales. If a farm residence is occupied by the persons farming the property, a one-acre parcel of land is valued at the farmland rate. The farm residence and one-acre parcel is classified in the residential tax class. The value of the residence on the one-acre parcel is determined by establishing a replacement cost less depreciation and the land is valued as farmland. Farm Ratio Comparison with Municipal Peers As part of the additional analysis, staff were asked to survey some other upper/single-tier rural municipalities to see if 2018 farm tax ratios have been approved and, more specifically, if there have been any reductions. The following Table reflects the responses received prior to submitting this report. Table 13 – Upper Tier/Single Tier Municipalities Comparison – 2018 Farm Ratio



Tax TaxFarm Land CVA $882,800 $1,041,300 $158,500 17.95% General tax rate 0.00094582 0.00077172 -0.00017410 -18.41% General tax $835 $804 -$31 -3.76%

Municipality 2018 Farm Ratio Comments

Brant County 0.24 ApprovedBruce County 0.25 ApprovedChatham-Kent 0.22 ApprovedDufferin County 0.25 considered but not yet adoptedGrey County 0.25 to be considered March 22Huron County 0.25 ApprovedLambton County 0.226 ApprovedMiddlesex County 0.25 to be considered March 27Perth County 0.25 under review - to be considered end of April Wellington County 0.25 Approved

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Conclusions The recommendations as summarized in Table 1 were formed based on collaborative perspectives of each of the Area Municipal Treasurers and/or Tax Collectors having regard for local impacts.

County Council is responsible for tax policy decisions that are sensitive to area municipal needs and priorities on an annual basis. The Area Municipal Treasurers and Tax Collectors’ participation in forming the recommendations for 2018 tax policy has been instrumental, as has the expert analysis provided by MTE. In addition to the reports and analysis presented to County Council, the Area Municipal Treasurers and Tax Collectors are a valuable resource for Councillors seeking clarity or an understanding of how these policy decisions affect their Area Municipality.

Based on the direction from Council and through the adoption of the recommendations contained in this report, staff will prepare the appropriate by-laws for enactment at the April 11, 2018 Council meeting.

SIGNATURES Departmental Approval: Original signed by: Lynn S. Buchner, CPA, CGA Director of Corporate Services Approved for submission: Original signed by:

Peter M. Crockett, P.Eng. Chief Administrative Officer ATTACHMENT Attachment No. 1 – Excerpt from Preliminary Reassessment Impact Study Notice - Based Data Version, prepared by Municipal Tax Equity (MTE) Consultants Inc., dated November 4, 2016

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Underline

CONFIDENTIAL PRELIMINARY ANALYSIS

© 2016 Municipal Tax Equity (MTE) Consultants Inc. Page | 11

Table 7 Progression of Preliminary Phased CVA 2017 to 2020

January 1, 2012

Base Value

Progression of CVA January 1, 2016

Destination Value / 2020 Full CVA

Realty Tax Class 2017 Phased 2018 Phased 2019 Phased

Taxable

Residential 9,211,362,750 9,363,625,487 9,598,507,439 9,833,389,388 10,068,271,337

Farm 3,432,131,800 4,181,395,025 4,931,771,950 5,682,148,875 6,432,525,800

Managed Forest 8,437,000 9,269,750 10,151,500 11,033,250 11,915,000

Multi-Residential 197,986,050 184,272,994 188,401,838 192,530,682 196,659,525

Commercial 993,509,314 1,000,831,263 1,050,057,407 1,099,283,560 1,148,509,701

Industrial 211,257,354 208,350,028 213,471,319 218,592,610 223,713,900

Large Industrial 371,090,225 371,855,975 385,799,350 399,742,725 413,686,100

Pipeline 231,964,000 236,082,750 240,201,500 244,320,250 248,439,000

Sub-Total Taxable 14,657,738,493 15,555,683,272 16,618,362,303 17,681,041,340 18,743,720,363

Payment in Lieu

Residential 1,015,600 1,121,625 1,241,950 1,362,275 1,482,600

Farm 88,000 102,450 116,900 131,350 145,800

Commercial 46,828,098 49,960,674 53,748,049 57,535,425 61,322,800

Industrial 2,394,100 2,385,350 2,477,800 2,570,250 2,662,700

Sub-Total PIL 50,325,798 53,570,099 57,584,699 61,599,300 65,613,900

Total (Taxable + PIL) 14,708,064,291 15,609,253,371 16,675,947,002 17,742,640,640 18,809,334,263

Note: Results are based on Notice Version Data and must be considered preliminary and subject to change.


PENDING ITEMS

Council Lead

Meeting Date Issue Pending Action Dept. Time Frame

24-May-17 Resolution No. 8 - Princeton Wastewater Servicing Solution Report PW Q-1 2018

24-May-17 5935-2017 - Natural Resource Gas Limited Franchise Agreement 3rd Reading PW Subject to

OEB Order

10-Jan-18 Resolution No. 8 - Blandford-Blenheim resolution requesting the County Report CP Q-1 2018

initiate a lands needs assessment including the need for future

residential growth - referred to Community Planning.

14-Mar-18 PW 2018-05 - Advancing Zero Waste - A Waste Recovery and Final Report PW June 2018

Reduction Technology Assessment Update

COUNTY OF OXFORD

BY-LAW NO. 6009-2018

BEING a By-law to confirm all actions and proceedings of the Council of the County of Oxford at the meeting at which this By-law is passed. The Council of the County of Oxford enacts as follows: 1. That all decisions made by Council at the meeting at which this By-law is passed, in respect

of each report, resolution or other action passed and taken by the Council at this meeting, are hereby adopted, ratified and confirmed.

2. That the Warden and/or the proper officers of the County are hereby authorized and directed to do all things necessary to give effect to the said decisions referred to in Section 1 of this By-law, to obtain approvals where required, and except where otherwise provided, to execute all necessary documents and the Clerk is hereby authorized and directed to affix the corporate seal where necessary.

3. That nothing in this By-law has the effect of giving to any decision the status of a By-law

where any legal prerequisite to the enactment of a specific By-law has not been satisfied. 4. That all decisions, as referred to in Section 1 of this By-law, supercede any prior decisions

of Council to the contrary. READ a first and second time this 11th day of April, 2018. READ a third time and finally passed this 11th day of April, 2018.

DAVID MAYBERRY, WARDEN

BRENDA J. TABOR, CLERK