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November 18, 1997, Toronto, ON -- The Health Services Restructuring Commission (HSRC), an independent body of health experts and professionals, today released its preliminary recommendations regarding the restructuring of health services in the GTA/905.

HSRC Chairman Dr. Duncan Sinclair announced that $329 million dollars in reinvestment is required to meet the health services needs of the GTA/905 residents to 2003. The reinvestment includes $185 million in annual funding for services such as long term care, home care, rehabilitation and mental health services. Also, $144 million in capital funding is needed for expansion and renovation projects, furniture and equipment.

"We are keenly aware that the GTA/905 is one of the fastest growing regions of the province, and we wanted to ensure the resources would be there to meet the health services requirements of the growing and aging population," said Dr. Sinclair, the recently retired Vice Principal of Health Sciences and Dean of Medicine at Queen's University.

"Our recommendations today represent the largest reinvestment in health services to date. The recommended capital funding is also among the highest the Commission has suggested to the Minister of Health," he said. "Our goal is to achieve the best possible publicly-funded health system for the people of Ontario. We believe our decisions will set the stage for building an improved and better coordinated health services system in the GTA/905, today and in the future."

The Commission's decisions will result in significant reinvestment and enhancement of services in the GTA/905, including:

• additional reinvestment of $329 million in services and capital redevelopment in the regions;
  
• a significant investment and additional capacity in long term care, rehabilitation and mental health services for residents of the GTA/905;
  
• additional capacity and capital funding to address population growth; and
  
• a significant expansion of emergency services and ambulatory care space in hospitals.

The Commission issued preliminary recommendations (Notices of Intention to Issue Directions or "Notices") and announced that there will be a 30-day response period. Interested organizations and individuals are invited to comment on the HSRC recommendations by December 19, 1997.

Report highlights

Highlights of the GTA/905 report on health services restructuring include:

• A comprehensive health system consisting of 10 hospitals on 15 sites, with a focus on regional health systems to improve access to a wide range of services and quality, and better coordinate patient services;
  
• A total of 4,562 inpatient beds to 2003, including acute care, sub-acute care, mental health, rehabilitation and complex continuing care to meet the needs of the growing and aging population;
  
• Enhanced services for the elderly, including:
  
  • 70 additional complex continuing care beds; and
    
  • 4,200 additional beds in nursing homes and homes for the aged; and
    
  • 5,100 places for supportive housing, long term home care, attendant care and adult day care;
• Enhanced mental health services for adults, children and adolescents, including:
  
  • a 73 percent increase in acute mental health beds;
    
  • 44 child and adolescent mental health beds distributed among the five regional inpatient paediatric centres; and
    
  • the Whitby Mental Health Centre to become a public hospital with its own local community board;
• A 213 percent increase in rehabilitation beds so GTA/905 residents can receive care closer to home;
  
• $185 million in reinvestment in services:
  
  • $25 million for acute home care;
    
  • $12 million for complex continuing care;
    
  • $78 million for long term care;
    
  • $22 million for sub-acute care;
    
  • $14 million in mental health services;
    
  • $30 million in rehabilitation services; and
    
  • $4 million to operate Magnetic Resonance Imaging units.
• $144 million for renovation and expansion projects, furniture and equipment; and
  
• $79 million in annual savings or 10 percent based on 1995/96 net expenses of $800 million.

In restructuring health services in the GTA/905, the Commission adopted an approach that goes beyond traditional regional boundaries and considers the interdependency of between Metropolitan Toronto and the GTA/905 as well as the interdependencies between the regions of the GTA/905.

"We recognize that the GTA functions as a single community for health services. Many GTA/905 residents live along the border of Metropolitan Toronto and are geographically closer to a hospital in Metro than one within their municipal region," said Dr. Sinclair. "We realized it didn't make sense to define services according to municipal boundaries. Instead, we evaluated acute care hospitals in clusters based on shared communities served and referral patterns."

The HSRC recommended the following governance and management structures:

Halton/Peel - North Cluster

• Georgetown and District Memorial Hospital, Peel Memorial Hospital and Etobicoke General Hospital in Metropolitan Toronto will amalgamate to form a new hospital corporation (North West GTA Hospital Corporation). All three sites will remain open.
  
  • The new hospital corporation will provide access to emergency services and inpatient services on all three sites. It also will ensure a range of clinical services on the Georgetown site to meet the needs of the north Halton community for primary and selected secondary inpatient care as well as complex continuing care.

• Milton District Hospital and Oakville-Trafalgar Memorial Hospital will amalgamate to form a new corporation ( East Halton Hospital Corporation).
  
  • The new hospital corporation will provide access to emergency services and inpatient services on both sites. It also will ensure a range of clinical services on the Milton site to meet the needs of the central Halton community for primary and selected secondary inpatient care as well as complex continuing care.
    
• Credit Valley Hospital and Joseph Brant Memorial Hospital will maintain their separate governance and management.
  
• The Mississauga Hospital and Queensway General Hospital to continue their progress towards amalgamation.

• York Central Hospital, York County Hospital and Markham Stouffville Hospital will maintain their separate governance and management.
  
  • The three boards will establish the York Region Hospitals Joint Planning Committee which will make decisions that support the development of an integrated system of care, as well as the scope and location of new programs, delivery of shared support services and linkages among the three hospitals and other health care providers.
    
• The HSRC will defer its advice to the Minister of Health regarding Shouldice Hospital, a private hospital, until discussions between the Ministry of Health and Shouldice Hospital are concluded.

• Ajax and Pickering General Hospital and Centenary Health Centre in Scarborough will amalgamate to form a new hospital corporation to meet the needs of residents in west Durham and east Scarborough (Ajax and Pickering/Centenary Hospital Corporation).
  
• Oshawa General Hospital, Memorial Hospital in Bowmanville, Whitby General Hospital and North Durham Health Services will amalgamate to form a single hospital corporation to provide service to residents in east and north Durham (East Durham Hospital Corporation).
  
  • The programs and services of Whitby General Hospital will be transferred to the Oshawa General and Ajax and Pickering sites, and the Whitby General site will close.
    
  • The HSRC will delay its decisions regarding the content and configuration of services for North Durham Health Services until the district health council completes its review of the rural health services.
    
  • The new corporation will be expected to establish a rural health services advisory committee of the Board.

The HSRC considered the need to locate additional specialized services such as cancer care, cardiovascular services, dialysis, trauma, high-risk obstetrics and neonatology, and orthopaedic services including hip and knee replacements within the GTA/905 regions.

"The starting point for these deliberations was the Commission's commitment to maximize the use of existing capacity in the specialized centres in Metropolitan Toronto and Hamilton," said Dr. Sinclair. "We support the location of services in the GTA/905 region as a priority when the availability of sufficient patients is demonstrated and additional service capacity within the GTA/905 as a whole is needed."

The HSRC concluded that:

• Additional reinvestment in the GTA/905 for orthopaedic services such as hip and knee replacements will be necessary to meet the needs of the growing and aging population.
  
• Additional reinvestments in cancer services will be considered once the district health councils in Central East Region have completed their review of recommendations concerning access to cancer services for residents of the GTA/905.
  
• An expert panel with a provincial mandate will be convened to advise on where to locate additional cardiovascular services.
  
• There was not sufficient evidence to support additional trauma, high-risk obstetrics and neonatology services in the GTA/905 at this time because demand is being adequately met by resources in Metropolitan Toronto and Hamilton.

The Commission expects implementation of its directions and recommendations for The GTA/905 to be completed by the year 2000.

Dr. Sinclair said the Commission believes its recommendations will lead to positive change. "The measures outlined today will lead to improved quality and better access to a wide range of services for the residents of the GTA/905. Our recommendations to reinvest in community-based services, and to upgrade and expand facilities will ensure that the health system will be able to meet the needs of the community well into the 21^st century."

The Health Services Restructuring Commission is a group of individuals appointed by the Government of Ontario to redesign the Ontario health system. It is an independent agency of doctors, academic health science professionals, hospital administrators, former hospital board members and other experts. The Commissioners work with local district health councils, hospital boards and other health professionals to restructure health services for each community. The Commission has a four-year mandate to restructure hospital systems and advise the Minister of Health on reinvesting in and restructuring other services to meet the health needs of the people of Ontario.