The Health Services Restructuring Commission (HSRC) has issued its directions to hospitals and recommendations to the Ministry of Health for restructuring hospital and other health services in Sudbury.

The Commission delivered notices of intention to issue directions on
Sept. 30, 1996, and 54 representations were sent to the Commission in the 30-day comment period following. Most supported creation of a single governance and single administration for all acute, chronic and rehabilitation hospital services in Sudbury.

The directions and recommendations reflect new information and data received by the Commission during the comment period.

Directions

• The Laurentian, Memorial and General hospitals will combine their activities and create a new Sudbury Regional Hospital Corporation by April 30, 1997.
  
• The Paris (Sudbury General) and Regent (Sudbury Memorial) sites will be decommissioned by March 31, 1999.
  
• All acute, chronic and rehabilitation services will be provided at the Ramsey (Laurentian) site by April 30, 1999.
  
• There will be 17 operating rooms, compared with the 12 recommended in the notices.
  
• The Sudbury Regional Hospital Corporation and Algoma Hospital will together operate a maximum of 565 beds, made up of:
  • 345 acute care beds
    
  • 66 adult psychiatric beds
    
  • 12 paediatric psychiatric beds
    
  • 100 chronic care beds
    
  • 31 rehabilitation beds
  This represents an increase of four new intensive care beds, 11 new acute care beds and 12 new mental health beds from the estimates in the notices.
• The Sudbury Regional Hospital Corporation will implement plans to reach utilization improvements in acute care that will result in rates of 697 days per 1,000 population by April 30, 1998, and 540 days per 1,000 population by April 30, 1999. The current rate is 854 days per 1,000 population.
  
• Sudbury Regional Hospital will be governed by a new board of directors that will be representative of the area's linguistic, ethnic, religious and cultural diversity.
  
• The three hospitals will use a facilitator to assist them in their planning for governance, administration and operations.
  
• There are a number of principles that the HSRC has articulated over time that guides its decision-making respecting governance:
  • the tradition of voluntary governance has served Ontario communities well over the past century and should be maintained and enhanced in a restructured health services delivery system
    
  • there are significant benefits to be derived from the diversity, tradition and culture of the broad array of hospitals and health care organizations in the province
    
  • diversity, tradition and cultural differences must not, however, stand in the way of the necessary shift from autonomy to interdependence to facilitate more effective and efficient services for patients
    
  • the priority of governance structures must be to promote the development of interdependencies on which a smoothly coordinated, strategically planned, functional system can be built and maintained
    
  • there is no one "best" system/model of governance, but there is a need to find better ways to promote greater integration, efficiencies and effectiveness across the various components of the hospital and health care system
    
  • new forms of governance should emerge in a manner that will contribute the strengths and talents of individual organizations to discharge their collective responsibilities and to preserve and enhance the distinctiveness of each of their organizations and institutions
• A governance plan for Sudbury hospital services will take into consideration:
  • the cultural, linguistic, religious and ethnic characteristics of the communities served
    
  • creation of a corporate entity that will govern the provision of hospital- based services in the community
    
  • the regional nature of many hospital-based services
    
  • the unique nature of hospital-based mental health services and the role of the Algoma Hospital/Network North
    
  • the contributions of the existing hospital boards as an important foundation in the creation of the new Sudbury Regional Hospital Corporation
• The HSRC looks forward to receiving a governance plan that addresses a number of issues including:
  • representation on the board of directors
    
  • membership of the corporation
    
  • mission of the Sudbury Regional Hospital Corporation
    
  • disposition of assets
    
  • relationships to charitable foundations

The Commission has recommended to the Minister of Health that:

• A capital budget of up to $76.5 million be approved for the Sudbury Regional Hospital Corporation to expand the Ramsey site (which includes $3.5 million for repatriated cases) and up to $9 million for equipment and furnishings. This is $4.8 million above the amount recommended in the September report. The expansion will accommodate the emergency department, day surgery and operating rooms, labour and delivery rooms, diagnostic imaging and other support services. The redeveloped hospital will have a total area of 649,000 sq.ft.
  
• Sudbury Regional Hospital be designated the regional trauma centre, with capacity for 93,500 emergency visits a year.

• $1.9 million for repatriation of orthopaedic and neonatal intensive care cases to Sudbury
  
• $1 million for MRI services
  
• $2.8 to $3.2 million for sub-acute/transitional care (a new level of service) for patients who no longer need an acute care bed but are not yet ready for discharge to their homes or to a long-term care facility
  
• $1.2 million for home care
  
• $3.3 million for recruiting and retaining new physicians - this money would be outside the OHIP pool
  
• $1.4 million for chronic care
  
• $0.6 million for rehabilitation
  
• $1.6 million for acute mental health

The HSRC supports moving the Children's Treatment Centre to the Regional Hospital site, possibly locating it in a separate facility, and recommends a short, focused review to ensure that the proposed scope of the centre is appropriate.

Consolidation of Support Services

Algoma Hospital, Sudbury General Hospital, Laurentian Hospital and Memorial Hospital will develop and implement a plan by April 30, 1997, to maximize the efficiency of administrative services, support services and diagnostic imaging.

Labour Adjustment

The HSRC has directed Algoma Hospital, Sudbury General Hospital, Laurentian Hospital and Memorial Hospital to work with their labour representatives to develop a human resources/labour adjustment plan by April 30, 1997.

Savings

The Commission estimates potential cost savings in three areas: program transfers, clinical efficiencies and administrative efficiencies. It calculates the total annual savings from restructuring the Sudbury hospital system will be approximately $40.7 million.

Integrated Delivery System

The Commission has recommended that the Ministry of Health ask district health councils in northeastern Ontario to submit plans for integrated delivery of health services by June 30, 1997.

Mental Health

The Commission has amended the recommendation in its notices regarding creation of a committee of Northeastern Ontario district health councils to develop a regional mental health plan. The Northeast Region Mental Health Advisory Committee, established by the six DHCs in the region, is near completion of its work. The HSRC recommends that it should continue its work, and adapt its planning to include the broad requirements outlined in the notices.

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