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The Health Services Restructuring Commission (HSRC) has issued directions and recommendations for restructuring hospital services in Lambton County. They are contained in the "notices of intention to issue directions" and the Lambton County Health Services Restructuring Report.

The Commission based its restructuring plan on the work carried out by the Lambton District Health Council, and on input from Lambton County's hospitals, organizations and individuals. The restructuring plan builds on the efforts of all three Lambton hospitals to work together to improve efficiencies and develop proposals and options for integration.

The HSRC's decisions are based on the criteria of quality, accessibility and affordability.

There is a 30-day period for the community to comment on the notices and recommendations, after which the Commission will issue its directions.

Summary of Notices to Issue Directions

• Sarnia General Hospital, St. Joseph's Health Centre and the Charlotte Eleanor Englehart Hospital (CEEH) will retain their separate governance structures but operate under one administration, with a single chief executive officer.
• By April 1, 1997, the three hospitals will have a common medical advisory committee and medical staff, and appoint a single chief of staff.
• Sarnia General and St. Joseph's will co-locate at the St. Joseph's site in Sarnia; CEEH will continue to operate in Petrolia.
• The current Sarnia General site will be decommissioned by 1999, after the two hospitals consolidate at the St. Joseph's site.
• By March 31, 1997, the two Sarnia hospitals must have reached agreement about each organization's responsibility for the capital planning and financing that will be necessary for their consolidation and co-location.
• By April 30, 1997, Sarnia General and St. Joseph's are to have reached an agreement regarding the transfer of ownership, from St. Joseph's to Sarnia General, of the buildings and land required to provide acute care services.
• By 1999, Sarnia General will operate 172 acute beds, 26 acute mental health beds for adults and three acute mental health beds for children and adolescents, and provide emergency services. (The HSRC report notes that, while it is able to determine the number of acute mental health beds required in Sarnia, many Lambton County residents receive mental health services in London and St. Thomas. It will finalize Lambton County's mental health requirements in the context of its review of mental health services throughout southwestern Ontario.)
• By 1999, St. Joseph's Health Centre will operate 24 rehabilitation beds and 101 chronic beds. St. Joseph's will also establish a 14-bed unit for transitional care, a new level of care in Ontario also known as sub-acute, for patients who do not need acute hospital inpatient services but are either not ready for discharge to their homes and communities or for whom alternative arrangements are not yet a vailable.
• St. Joseph's, CEEH and Lambton County's Placement Coordination Service will develop and implement a plan to coordinate access to chronic care services for residents of Lambton County.
• CEEH will retain its hospital designation, but will be transformed into a rural primary care facility that will be a centre for community care. It will provide primary, medical and surgical, maternal and paediatric, mental health and urgent care. Its emergency department will be converted into an 18-hour "urgicentre" - a centre for assessment and treatment of urgent but not life-threatening conditions, such as minor lacerations, simple fractures and acute episodes of illness that require only brief treatment. Its acute inpatient caseload - which has been declining steadily for the past four years - will be transferred to Sarnia General Hospital. Pending further research by the Commission, CEEH will continue to operate its chronic care program.
• CEEH's programs will have two key components:
  
  • ambulatory clinical services, including urgent care, and
    
  • targeted community health programs focusing on promotion of health and prevention of disease; for example, asthma education programs, cardiac prevention and rehabilitation programs, and seniors' support initiatives.
• The hospitals will be expected to develop and implement a plan to achieve utilization improvements in acute inpatient care, not including mental health, that will result in a target utilization rate of 500 patient days per 1,000 population by March 31, 1999. Their 1994/95 rate is 719 days per 1,000 population. Utilization improvements are expected to result in an interim target of 650 patient days per 1,000 by March 31, 1997, and 571 by March 31, 1998. This represents a reduction from 322 beds in 1994/95 to 172 acute and 14 transitional beds in 1999.

The HSRC is recommending that the Ministry of Health provide additional funding for transitional care and community services to offset the impacts of hospital restructuring and meet the county's mental health needs.

• transitional care $515,000 to $595,000
• home care (an additional 28,000 visits annually) $1,106,000
• rehabilitation beds $354,000
• mental Health $1,214,000

• The Commission recommends that up to $21.7 million be budgeted for enlarging and renovating the St. Joseph's site to allow for the consolidation of the two hospitals' acute and chronic services at one site. A further $4 million will be budgeted for furnishings and equipment. The redeveloped site housing the two hospitals will be 393,000 square feet.
• The Commission recommends that up to $2.5 million be allocated to CEEH for renovations to accommodate its new ambulatory activity.

The Commission estimates that savings will result from program transfers and reduced activity, clinical efficiencies, administrative efficiencies and centralization of support services.

Restructuring the Lambton County hospital system will result in annual savings of approximately $22 million.

Labour Adjustment

All three hospitals will work with employee representatives to develop a human resources adjustment plan by March 31, 1997.

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