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August 13, 1997, Ottawa, Ontario -- The Health Services Restructuring Commission (HSRC), an independent body of health experts and professionals, today released its final directions regarding the restructuring of health services in Ottawa-Carleton.

HSRC Commissioner George Lund unveiled a comprehensive redesign of health services for Ottawa-Carleton that goes beyond hospital-based services to include essential reinvestment in rehabilitation, sub-acute care, home care and long term care.

"Our goal is to achieve the best possible publicly-funded health system for the people of Ontario," said Mr. Lund, a former chairman of Network North/Algoma Hospital. "We believe our recommendations will set the stage for building an improved and better coordinated health services system in Ottawa-Carleton, today and in the future."

Report highlights

• Ottawa-Carleton will have a comprehensive health system to meet residents' needs to 2003, including:
  
  • 1 amalgamated hospital with two full service sites, one with a greater emphasis on specialized services;
    
  • 1 full service hospital;
    
  • 1 hospital with limited inpatient services for low risk obstetrics, mental health and long term care as well as ambulatory care services;
    
  • 1 regional children's hospital;
    
  • 1 regional rehabilitation hospital;
    
  • 1 regional mental health facility for longer term and forensic mental health services; and
    
  • 1 complex continuing care hospital.
• Ottawa-Carleton will be able to meet the growing need to provide services to the elderly, with 2,639 additional long term care places needed to 2003:
  • 1,016 more beds in nursing homes and homes for the aged; and
    
  • 1,623 more places in community settings (e.g., supportive housing, long term home care, attendant care and adult day care).
• The Ottawa Civic, Ottawa General and Riverside hospitals will amalgamate to form The Ottawa Hospital/L'Hôpital d'Ottawa, the region's pre-eminent teaching and research facility.
  
  • most specialized services and programs will be located at the Alta Vista (Ottawa General site) along with primary and secondary care;
    
  • primary and secondary care also will be available at the Carling site (Ottawa Civic);
    
  • The University of Ottawa Heart Institute will retain its own governance, subsidiary to The Ottawa Hospital/ L'Hôpital d'Ottawa, and will take on a larger role as the main provider of cardiac services in the region; and
    
  • The Rehabilitation Centre will have its own governance, subsidiary to The Ottawa Hospital/ L'Hôpital d'Ottawa, and will provide leadership in rehabilitation services.
• Hôpital Montfort will remain with its own governance and assume a new role providing a inpatient services including low risk obstetrics, acute and longer term mental health services. It will also provide ambulatory care and long term care.
  
• Hôpital Montfort will take the leadership role in the new Ottawa-Carleton French Languages Health Services Network which will help ensure services are available in French in other hospitals and agencies.
  
• Additional mental health beds to meet the needs of the population and the creation of a Regional Mental Health Agency to implement and monitor mental health restructuring within a protected envelop of funding.
  
• With the closure of Brockville Psychiatric Hospital, the outpatient and community-based programs now offered in Brockville and Cornwall will remain in these communities, and will be governed and managed locally. Brockville General Hospital will provide acute inpatient services to meet the needs of Leeds and Grenville residents.
  
• A regional Child Health Network will coordinate paediatric services, including child and adolescent mental health services.
  
• A more comprehensive range of rehabilitation services including more beds will be put in place. The Rehabilitation Centre will lead the ongoing work of the Rehabilitation Network to create a collaborative approach to rehabilitation services in the region.A reinvestment of $41.5 million is recommended:
  
  • $18.9 million in long term care;
    
  • $5 million in home care;
    
  • $6.6 million in rehabilitation;
    
  • $9 million in sub-acute care (for people who need acute care such as nursing and therapy, but do not require daily physician involvement); and
    
  • $2 million for Magnet Resonance Imaging (MRI) services.
• Recommended reinvestment of $128 million in construction, renovation and equipment to enable the remaining facilities to embark on major renewal projects.
  
• $100 million in annual savings based on 1995/96 net expenses of $733.5 million..

The HSRC received 442 representations and community campaigns generated thousands of signatures, faxes and telephone calls during the response period. The Commission reviewed all the submissions and conducted additional research and analysis. This resulted in several changes to our intended directions issued in February.

The need for a French milieu to train medical students and other health professionals as well as maintenance of accessibility to health services in French emerged as key issues. The Commission acknowledges that medical students and other health sciences students must be able to train in a French milieu. It also recognizes that Francophones must continue to be able to obtain all levels of health services in French in Ottawa-Carleton.

"The Commission has decided that Hôpital Montfort must remain and assume a new role. Hôpital Montfort will retain its own governance and continue to provide a French milieu for the education and training of francophone health professionals and to provide health services to the francophone community," Mr. Lund said.

Hôpital Montfort will provide day surgery, primary care, low risk obstetrics, and acute and longer term mental health services, ambulatory services including a 24-hour access to urgent care. The Commission also is advising Hôpital Montfort to acquire a license for long term care beds to help meet the demand for long term care services among the francophone community. These services and programs will provide a milieu for the training and education of medical students and other health professionals.

The HSRC wants to ensure access to French language services in other hospitals so that the full range of health services is available to Francophones. The following hospitals/sites will be directed to seek full designation: Alta Vista site, The Rehabilitation Centre and Heart Institute of The Ottawa Hospital/L'Hôpital d'Ottawa; Children's Hospital of Eastern Ontario and the Sisters of Charity of Ottawa.

Hôpital Montfort will assume the leadership of a regional French Language Health Services Network to ensure that francophones in the Ottawa-Carleton region -- and beyond - will have access to a full range of quality services offered in French. The network will include hospitals directed by the HSRC to seek designation, the University of Ottawa, la Cité collegiale and other community services. The network will assist hospitals in obtaining designation and identify gaps in the delivery of services in French.

"We view the French Language Health Services Network as an enabling measure," said Mr. Lund, "Francophones will have a significant role in ensuring that a full range of health services are available."

Another issue raised in the submissions centered on the need to differentiate the roles of the two teaching hospitals within the amalgamated organization. With this in mind, the Commission has determined that all specialty programs and services will be transferred to the Alta Vista site (formerly Ottawa General Hospital). The Carling site (formerly the Ottawa Civic Hospital) will concentrate on primary and secondary care.

The Commission considered numerous options for redesigning acute care services in Ottawa-Carleton. Its analysis showed that closing the Ottawa Civic Hospital would jeopardize the quality, accessibility and cost-effectiveness of the local health system.

"Population growth is the fastest in the west end of Ottawa-Carleton and the Ottawa Civic Hospital has the largest volume of any other hospital. Closing the Ottawa Civic would impact accessibility and potentially overload the other hospitals. The site must remain open in order to meet the health needs of the population," said Mr. Lund.

Rehabilitation and long term care

The HSRC also issued preliminary recommendations (Notices) regarding rehabilitation and long term care services. The deadline for representations for long term care and rehabilitation services is September 27, 1997.
A total of 189 rehabilitation beds will be needed to 2003 (compared to the current 124 beds), requiring $6.6 million in reinvestment. Services will be provided in the following manner:

• Short term rehabilitation beds will be located at the Carling site of The Ottawa Hospital/L'Hôpital d'Ottawa, Queensway-Carleton Hospital and The Rehabilitation Centre (TRC).
  
• TRC will be the designated regional facility providing specialized rehabilitation programs (i.e., acquired brain injury, spinal cord injury, trauma, etc.).
  
• St. Vincent Pavilion of the Sisters of Charity of Ottawa will provide long term local rehabilitation services.

• All chronic care will be consolidated at St. Vincent Pavilion of the Sisters of Charity of Ottawa.
  
• The Queensway-Carleton Hospital will no longer provide chronic care.
  
• Hôpital Montfort and Elisabeth Bruyère site of the Sisters of Charity of Ottawa will also cease to offer chronic care. The Commission recommends that the Sisters of Charity of Ottawa and Hôpital Montfort submit proposals or applications to the Minister of Health to provide long term care services.

The Commission expects implementation of its directions and recommendations for Ottawa-Carleton to be completed by December 1999. To facilitate implementation of restructuring, the HSRC recommends a transitional Restructuring Implementation Coordination Task Force (RICTF) for all acute, chronic and rehabilitation services.

Mr. Lund 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 Ottawa-Carleton and beyond. 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.