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LONDON, February 26, 1997 - The Health Services Restructuring Commission (HSRC) today released its report and recommendations on restructuring hospital services in London. The HSRC also issued its plan for chronic mental health services in southwestern Ontario.
The restructuring plan, based on criteria of quality, accessibility and affordability, is contained in notices of intention to issue directions that the HSRC delivered today to local hospitals, the Thames Valley District Health Council (DHC), representatives of the University of Western Ontario and the Minister of Health.
The report also contains recommendations to the Minister of Health on additional funding to help community agencies meet additional demands that will be placed on them by changes to London's hospital system.
There is a 30-day period during which local organizations and individuals are invited to submit written comments. After considering any new information received during this period, the HSRC will issue its directions to hospitals and recommendations to the Minister of Health.
"Like many communities across the province, London and its surrounding communities have recognized the need to change the way their health care services are organized and delivered," said commissioner Doug Lawson. "Over the last few years, hundreds of citizens have given their time and energy to examine the state of health care, and to offer ways to improve service effectiveness and efficiency."
The HSRC based its decisions on the work of the London Acute Care Teaching Hospitals' Restructuring Committee (LACTHRC) formed by the DHC, on Ministry of Health analysis, on submissions from health care providers and the public, and on its own studies and site visits.
It also made use of studies carried out by the Provincial Psychiatric Hospitals Restructuring Committee of the District Health Councils of Southwestern Ontario and Waterloo and Haldimand-Norfolk, and by the Mental Health Reform Planning Committee of the Thames Valley District Health Council.
Concerning mental health services in southwestern Ontario, Lawson said the HSRC agrees that these services should be decentralized, and provided in the community to the greatest extent possible. The HSRC is recommending a regional mental health authority be established to co-ordinate planning, implementation and ongoing monitoring of mental health services in southwestern Ontario.
As part of this process, St. Thomas Psychiatric Hospital and London Psychiatric Hospital will close.
There will be 66 acute mental health beds for Middlesex County at the Westminster and University sites of the London Health Sciences Centre. Sixty-five forensic beds will remain at the St. Thomas Psychiatric Hospital site, but be located in a newly-constructed facility on the site. In addition, the HSRC has determined that 13 acute mental health beds are needed in Elgin County and 17 in Haldimand-Norfolk.
To fulfil the goal of decentralizing chronic mental health care, 120 chronic beds will be located at the Grosvenor or Parkwood site, 50 beds in Windsor, and 47 in Waterloo.
As a result of these changes, about $46 million will be available for reinvestment in mental health services.
"I want to assure you that closing the two psychiatric hospitals and decentralizing chronic mental health services will not take place until the necessary structures and community supports are in place," said Lawson.
With respect to other hospital services, and as part of the restructuring plan, the London Health Sciences Centre will provide all acute inpatient services, including emergency services, at the Westminster and University sites by Dec. 31, 1999. The Centre's South Street site will be closed by that date, and all services transferred to the other two sites.
The London Health Sciences Centre will govern the hospital services carried out at the two sites. It will have an operating budget of about $375 million.
St. Joseph's Health Centre's Grosvenor site will operate a hospital that will provide ambulatory care, outpatient services, day surgery and low-risk obstetrical services. It will not provide acute inpatient care. In co-operation with the other London health care facilities, this hospital will function as a key component of the local health care system.
St. Joseph's Health Centre will govern all the services at the Grosvenor site, chronic mental health services in London, and forensic mental health services in southwestern Ontario.
In addition, St. Joseph's will assume ownership, operation, management and control of the Parkwood Hospital, which will continue to serve in its long-term care and rehabilitation role. The reason for this is that, although St. Joseph's, at its St. Mary's site, and Parkwood provide similar rehabilitation and long-term care services, St. Joseph's has a long history of also providing acute care, and has established a significant focus in the area of ambulatory and maternal care. St. Joseph's will have a combined operating budget of about $116 million.
St. Joseph's is directed to put in place a governance structure representative of the community served, and to ensure that, for an initial three-year period, one-third of the board of directors is appointed from a list of candidates provided by the Parkwood Hospital board of directors.
"The Commission's directions build on the work of the DHC's LACTHRC, as well as on the work of hospitals, and input from the health community and the general public," said Lawson. "However, we want to ensure that implementation of this plan will achieve the best possible configuration and integration of health services, and that it will maintain and enhance London's important education and research activities"
To achieve that end, the HSRC is recommending that a joint committee of the London Health Sciences Centre, St. Joseph's Health Centre and the University of Western Ontario be formed by July 31, 1997 to facilitate and accelerate restructuring. Until July 31, 2000, both hospitals will appoint an equal number of board members to this joint committee. The HSRC has asked the university to appoint up to three members to represent its interests concerning education and research at the hospitals.
The joint committee will look at restructuring of hospital services, allocation of services, the continuum of care provided to patients, financial and operating plans, and development of integrated administrative and medical staff structures. It will also address the effect the restructuring plan will have on hospital-based education and research.
The Commission has identified a need to better co-ordinate pediatric services, both regionally and at the provincial level. It has asked that, with the leadership of the Children's Hospital of Western Ontario, a regional paediatric network be established to co-ordinate planning and delivery of children's services in the region. The network will include broad representation from southwestern Ontario communities and providers. In addition, a provincial task force of the five health sciences centres and hospitals that provide specialized pediatric services will develop, by October 31, 1997, a plan to consolidate these services across the province.
The Commission is undertaking research into long-term and rehabilitative care throughout the province. This research will establish policy and planning targets to guide its decisions in these areas. It is anticipated that the research will be completed by early March. Following a period of consultation, the policy will be applied in restructuring decisions for communities across the province.
Compared with the provincial average, London is well-served with long-term care beds, and there is vacant capacity at both the Parkwood Hospital and the St. Mary's site of St. Joseph's to accommodate long-term care patients. Based on current planning targets, the Commission has determined that no additional chronic care beds are needed in London.
The HSRC is advising the Minister of Health to revoke Grace Villa's private hospital licence by Aug. 31, 1997, and to transfer patients to either Parkwood, the St. Mary's site, or other long-term care facility depending on patients' needs. This will be done in conjunction with St. Joseph's and the placement coordination service.
Once the plan has been implemented, London will have 840 acute care beds, 66 acute mental health beds, 23 children's mental health beds, 78 rehabilitation beds and 251 chronic care beds.
The HSRC estimates savings of $70.74 million out of the 1995/96 budget of $564 million.
These savings do not include the $45.7 million that will be saved by closing the London and St. Thomas Psychiatric hospitals. The HSRC is recommending to the Minister of Health that this $45.7 million should be reinvested in community mental health care throughout the region.
The HSRC is recommending additional reinvestments of $1.3 million in home care services, adding 40,000 home visits, and $883,000 to $1,010,000 for transitional, or sub-acute care.
The recommendation for capital expenditures to facilitate restructuring is between $147.3 and $150 million.
Lawson said that the HSRC is very aware that the actions that must be taken to preserve Ontario's health services and create a genuinely co-ordinated and integrated health care system will displace many workers.
"We are directing all the hospitals, including the two psychiatric hospitals, to continue the work they have already begun, with representatives of affected employees, to develop human resources plans to address the impact of restructuring on workers," he said. "As well, the Commission will appoint a fact-finder to advise it on a mechanism to address the impact restructuring will have on physicians."
The Health Services Restructuring Commission is an independent and expert agency of the Ontario government with a four-year mandate to restructure health services across the province. Its mandate is to direct hospital restructuring and advise the Minister of Health on reinvesting in and restructuring other health services to improve quality and patient outcomes.
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Media contact: Ruth Lewkowicz (416)327-5919
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