Radiation Treatment Capital Investment Strategy COORT Presentation

Success of Previous Capital Investment Strategies Historically CCO has been very successful in the planning and implementation of capital initiatives  The first Capital Plan resulted in new facilities in Grand River, Peel and Durham.  The second Plan resulted in the construction of new facilities in Newmarket, Barrie, Niagara and Algoma and redevelopment of the existing Centres in Ottawa and Kingston. Investments in the development of cancer treatment facilities and radiation equipment have taken the provincial number of radiation treatment units from 65 in the year 2000 to 103 units in Investments in two portable treatment units created flexible treatment spaces in Ottawa and Barrie. Ottawa facility redeployed to Peterborough in 2013 and the Barrie facility will redeploy in 2015 to a location to be determined. 2

Capital Investment Strategy Purpose  Provide advice on the development of a Capital Investment Strategy for provincial radiation treatment services compliant with CCO’s Provincial Radiation Treatment Program’s Goals.  The plan maximizes the use of existing investments in equipment and infrastructure while ensuring the appropriate tools are in place to provide equitable access to quality care. Develop recommendations for: New Facilities and Equipment Radiation Equipment Replacement Principles Improve access to care for cancer patients Keep pace with technology to ensure the delivery of quality care Ensure value for investments Minimize costs 10 year planning horizon 3

Existing facilities 4 Including portable bunker in Barrie and Ottawa’s room relocated to Peterborough Current MOHLTC equipment approvals result in 103 units There are 6 rooms that were constructed with no funding for equipment There are 10 rooms designated as swing bunkers to facilitate equipment replacements

Investments in Facilities – revised planning assumptions 5 Multi-disciplinary provincial committee met to update capital planning assumptions The revised planning assumptions result in the additional treatment machine capacity to treat 3,371 patients per year Based on an average of 445 patients per treatment unit these new operating parameters result in a reduced machine requirement of 7.5 treatment units.

Note: Projected demand is driven by the 3% annual increased incidence of cancer and a small increase in RT Utilization (Projected RT Utilization rate in 2020 of 42% vs. CCO target of 48%) Machine timing based on requests in Business Plan and deployment timeframes of 12 to 16 months. To support growth in incidence of 3% per annum, with 103 machines in operation equates to 3 additional machines per year To provide capacity to increase utilisation rates by.5% per annum adds another 1.5 units per annum A reduction in the improvements in utilisation rates from.5% to.3% results in a machine requirement reduction of 5 machines by Investments in Facilities - Capacity

Machine Requirements by Region Regional Distribution of Services based on current referral patterns adjusted for the introduction of new centres in Niagara and Barrie Did not round up partial machines and would rely on referral shifts to compensate for capacity gaps, assumes patients will travel to where capacity exists Gradual ramp up to 12 hours dependent upon availability of operating funds completed by 2015 Equip existing rooms first, plan additional capacity beyond 2018 through construction of new facilities in 4 regions Investments in Facilities – Demand/Capacity projections

Radiation Equipment Replacement Fund CCO employs a Radiation Treatment and Related Equipment Replacement Strategy that has been developed to:  Provide maximum equipment uptime thus minimizing unforeseen interruptions in patient care due to equipment failure  Minimize product obsolescence such that patients and staff in Ontario benefit from current technological innovation to improve throughput and patient outcomes. CCO through its annual provincial multi-disciplinary review process prioritizes all requests for replacement grant funding based on criteria which consider; improved access to care, quality, impacts on operating costs and the provincial context to allocate $29.5M in annual funding Over the past the decade there had been a 50% increase in the number of treatment units providing care to patients across the province. During this period there had not been any increase in base funding to replace treatment units. 8

9 Developed Alternative Approaches Implemented performance targets to ensure the grant funding is deployed in a timely manner to maximize its benefit Developed strategies and recommendations to improve the utilisation of limited funding associated with radiation replacement funding. Extending Average Equipment Lifecycles Function of the Grant Value for Money Implementation of updated strategies included the development of 5 year local radiation replacement plans with each hospital to inform local capacity planning and fundraising requirements Implementation of new approaches and additional $31.5M in 2012/13 in one time funding closed the gap between projected need and projected funding