Restructuring Report attached
News Release attached
Backgrounder attached

• ADVICE TO THE MINISTER OF HEALTH CONCERNING REINVESTMENT AND OTHER RESTRUCTURING ISSUES RELATED TO THE SUDBURY AND NORTHEASTERN ONTARIO REGIONAL HEALTH CARE SYSTEM
• Mental Health
• Human Resources
• Governance
• Laboratory Services
• Children's Treatment Centre
• Integrated Delivery System
• THE HEALTH SERVICES RESTRUCTURING COMMISSION HAVING ISSUED THE NOTICES OF INTENTION ON SEPTEMBER 30, 1996 AND HAVING CONSIDERED THE REPRESENTATIONS RECEIVED IN RESPONSE DIRECTS the board of directors of the Sudbury General Hospital to undertake the following:
• ADVICE TO THE MINISTER OF HEALTH CONCERNING SUDBURY GENERAL HOSPITAL
• THE HEALTH SERVICES RESTRUCTURING COMMISSION HAVING ISSUED THE NOTICES OF INTENTION ON SEPTEMBER 30, 1996 AND HAVING CONSIDERED THE REPRESENTATIONS RECEIVED IN RESPONSE DIRECTS the board of directors of the Sudbury Memorial Hospital to undertake the following:
• ADVICE TO THE MINISTER OF HEALTH CONCERNING SUDBURY MEMORIAL HOSPITAL
• THE HEALTH SERVICES RESTRUCTURING COMMISSION HAVING ISSUED THE NOTICES OF INTENTION TO ISSUE DIRECTIONS ON SEPTEMBER 30, 1996 AND HAVING CONSIDERED THE REPRESENTATIONS RECEIVED IN RESPONSE DIRECTS the board of directors of the Laurentian Hospital to undertake the following:
• ADVICE TO THE MINISTER OF HEALTH CONCERNING LAURENTIAN HOSPITAL
• THE HEALTH SERVICES RESTRUCTURING COMMISSION HAVING ISSUED THE NOTICES OF INTENTION TO ISSUE DIRECTIONS ON SEPTEMBER 30, 1996, AND HAVING CONSIDERED THE REPRESENTATIONS RECEIVED IN RESPONSE DIRECTS the Board of Directors of the Sudbury Algoma Hospital to undertake the following:
• ADVICE TO THE MINISTER OF HEALTH CONCERNING SUDBURY ALGOMA HOSPITAL
• DRAFT NOTICE OF INTENTION TO ISSUE DIRECTIONS TO THE SUDBURY REGIONAL HOSPITAL CORPORATION:
• DRAFT NOTICE OF ADVICE TO THE MINISTER OF HEALTH CONCERNING THE NEW SUDBURY REGIONAL HOSPITAL CORPORATION

Health Services Restructuring Commission

ADVICE TO THE MINISTER OF HEALTH CONCERNING REINVESTMENT AND OTHER RESTRUCTURING ISSUES RELATED TO THE SUDBURY AND NORTHEASTERN ONTARIO REGIONAL HEALTH CARE SYSTEM

1. The Ministry of Health reinvest in community services, particularly home care and related services, to mitigate the impact of the improvements to the rate of utilization in hospital services.

• Transitional care $2.8 - 3.2M
• Home care $1.2M
• Specialist Recruitment $3.3M Note: This special pool of funds should be established to address the under supply of specialists in Sudbury. These funds should not be part of the current OHIP pool but be transferred to the community to be managed locally for the sole purpose of recruiting and compensating specialists.
• Repatriation $2.0M
• Magnetic Resonance Imaging $1.0M Note: Ministry guideline of $150 K assumes balance of costs funded by hospital through internal cost savings. These internal cost savings have been removed, and further investment is required.
• Chronic Care $1.4M
• Rehabilitation $0.6M
• Acute Mental Health $1.6M

2. The Ministry of Health and the new Sudbury Regional Hospital Corporation should resolve as soon as possible the allocation of an MRI device to Sudbury to serve Northeastern Ontario at the Ramsey site.

3. The new Sudbury Regional Hospital Corporation should be given approval to plan for a capital construction project which will consist of the renovation and expansion of the Ramsey site. The expansion will accommodate the emergency department, day surgery and operating rooms, labour and delivery rooms, and diagnostic imaging such as the CT scanner and an MRI, and other support services. The total budget for the construction project, including construction costs, contingencies, and site development, should be set at a maximum of $72.1 million for recommended levels of acute, chronic and rehabilitation inpatient and outpatient services plus an additional $3.5 million for repatriation of neonatal and orthopaedic caseload for a total of $75.6 million. The total budget for equipment and furnishings should be set at a maximum of $9 million. The cost of the construction project and equipment and furnishings should be funded by the Ministry of Health and the hospital according to prevailing Ministry of Health policy.

The Sudbury Algoma should be approved for up to $0.87 million in capital to upgrade its facilities.

Mental Health

4. Instruct the Northeast Region Mental Health Advisory Committee of the district health councils of northeastern Ontario to develop a regional mental health plan, in conjunction with the public hospitals and the provincial psychiatric hospital, the community based mental health agencies, and consumer/survivor and community representatives. In that plan, consideration must be made to a governance structure for all hospital based mental health services, including all hospital based acute, psychogeriatric and rehabilitation mental health services and programs. The governance structure must be representative of the communities served and that have regard to the north east region's demographic, cultural, economic, geographic, ethnic, religious and social characteristics.

5. The plan shall also include:

I) the number of beds, supportive housing, community mental health services required at the provincial planning ratios of 30 beds per 100,000 population and related planning ratios;

II) the appropriate sizing and siting of all inpatient and outpatient mental health services among public hospital and the provincial psychiatric hospital;

III) the estimated savings from the hospital sector related to:

a) downsizing of inpatient clinical activity from current levels to planned levels;

b) consolidation and reduction of support services;

c) consolidation and reduction of administration;

d) improvement in efficiency (i.e., equity) in the provision of services and programs;

e) the transfer of clinical activity between facilities.

IV) the estimated reinvestment requirements in:

a) supportive housing

b) crisis intervention

c) community-based services

d) primary care and prevention

e) physician services

V) the additional physician and other professional manpower requirements by community

VI) the establishment of an regional agency and governance structure to plan for and purchase mental health services from a variety of providers but not deliver services directly.

6. The plan shall be submitted to the Commission and the Ministry of Health by no later than March 31, 1997.

7. Review and respond to the plan by no later than April 30, 1997.

Human Resources

8. Receive a human resources adjustment plan by no later than April 30, 1997.

9. Review and respond to the plan by no later than May 31, 1997.

Governance

10. Receive a plan outlining the Governance structure of the new Sudbury Regional Hospital Corporation by no later than January 31, 1997

11. Review and approve the Governance structure of the new Sudbury Regional Hospital Corporation by no later than February 28, 1997

Laboratory Services

12. Receive a plan for the hospital laboratory and pathology services in the Sudbury hospitals that is consistent with the directions of the Ministry of Health's Laboratory Reform Strategy by no later than April 30, 1997.

13. Review and respond to the new Sudbury Regional Hospital Corporation by no later than May 31, 1997.

Children's Treatment Centre

14. Receive a plan for the relocation of the Children's Treatment Centre to the Ramsey site no later than March 31, 1997.

15. Review and respond to the plan by no later than April, 30, 1997.

Integrated Delivery System

16. Establish, in conjunction with the HSRC, by January 31, 1997, a planning committee comprised of representatives of the northeastern region of the province to do the following:

a) examine the options for integrated delivery system(s) in northeastern Ontario including a single governance model;

b) evaluate the options and make recommendations by no later than July 31, 1997.

c) recommendation should include:

• identification of the selected model of integrated delivery system;
• costs and benefits of the selected model over time;
• costs and schedule for implementation including key milestones;
• an evaluation framework;
• governance and management arrangements of the selected model.

DATED at Toronto this 16 day of December, 1996

_______________ Chair

Health Services Restructuring Commission

12^th Floor

56 Wellesley Street West

Toronto, Ontario

M5S 2S3

Tel: (416) 327-5919

FAX: (416) 327-5689

To: The Honourable Dave Johnson

Minister of Health

10^th Floor, Hepburn Block

Toronto, ON M7A 2C4

Health Services Restructuring Commission

DIRECTIONS

THE HEALTH SERVICES RESTRUCTURING COMMISSION HAVING ISSUED THE NOTICES OF INTENTION ON SEPTEMBER 30, 1996 AND HAVING CONSIDERED THE REPRESENTATIONS RECEIVED IN RESPONSE DIRECTS the board of directors of the Sudbury General Hospital to undertake the following:

1. Led by a facilitator appointed by the Health Services Restructuring Commission, develop a plan, in conjunction with the Laurentian Hospital, and Sudbury Memorial Hospital, to create a new hospital corporation (the "Sudbury Regional Hospital Corporation") to assume the governance and provision of all hospital based acute, chronic and rehabilitation services and programs in the Sudbury area. The governance structure must be representative of the communities served and have regard to the demographic, cultural, economic, geographic, ethnic, religious and social characteristics of the Sudbury and the Northeast Region of Ontario. The plan must be submitted to the Health Services Restructuring Commission and the Ministry of Health by no later than January 31, 1997. The new Sudbury Regional Hospital Corporation shall be created no later than April 30, 1997.

2. The plan must address the unique status of hospital based mental health services and provide for the access, and coordination, and funding of all hospital-based mental health services by the Sudbury Algoma Hospital/Network North as an interim step pending the outcome of the regional mental health plan.

3. The plan must provide for the transfer of hospital assets, no later than 30 days after the formation of the new Sudbury Regional Hospital Corporation or such date as the Health Services Restructuring Commission may direct, and recommend appropriate compensation to the extent that any assets to be transferred have not been paid for, directly or indirectly, by funds received from the Crown.

4. By January 31, 1997 pass a resolution that would prohibit the transfer of any funds and assets from the hospital corporation to any related hospital foundation or any other person without a further direction from the Health Services Restructuring Commission.

5. Pending creation of the new Sudbury Regional Hospital Corporation, work in conjunction with Laurentian Hospital, Sudbury Algoma Hospital and the Sudbury Memorial Hospital and representatives of affected employees to submit to the Health Services Restructuring Committee and the Ministry of Health a human resources adjustment plan by April 30, 1997 that will address the impact of the implementation of the directions on the hospital's employees, including the transfer of programs to other hospitals, the reduction in utilization rate, the reduction in the number of beds and the consolidation of acute services.

6. Pending creation of the new Sudbury Regional Hospital Corporation, work in conjunction with Sudbury Memorial Hospital, the Laurentian Hospital and the Sudbury Algoma Hospital to submit to the Health Services Restructuring Commission by April 30, 1997 a plan to maximize the efficiency of the delivery of administrative services, support services and diagnostic services (e.g. laboratory services) of the hospitals and other health care facilities in Northeastern Ontario. The plan must address alternative services delivery systems, including services that can be provided by the private sector.

7. Pending creation of the new Sudbury Regional Hospital Corporation, work in conjunction with Sudbury Memorial Hospital, the Laurentian Hospital and the Sudbury Algoma Hospital to develop and submit to the Health Services Restructuring Commission and the Ministry of Health by April 30, 1997 a plan for the hospital laboratory and pathology services in the Sudbury hospitals that is consistent with the directions of the Ministry of Health's Laboratory Reform Strategy. As part of the plan, consolidate all hospital based laboratory services in a single site with one program for all hospital based laboratory and pathology services.

8. Submit to the Ministry of Health and the Health Services Restructuring Commission quarterly progress reports on the status of the implementation of the above directions, including a progress report on the implementation of the human resources adjustment plan. The first report is to be received at the latest by April 30, 1997 for the period ending March 31, 1997.

The Health Services Restructuring Commission further directs the Sudbury General Hospital to take all proceedings, corporate and otherwise, to implement such directions.

Accompanying these Directions are:

1. Copies of the Directions to the other hospitals in the Regional Municipality of Sudbury including the draft notice to the new Sudbury Regional Hospital Corporation;

2. Copies of the recommendations the Health Services Restructuring Commission has provided to the Minister of Health of Ontario;

3. A copy of the Sudbury Health Services Restructuring Report (December 1996) prepared by the Health Services Restructuring Commission.

DATED at Toronto this 16^th day of December, 1996

_______________ Chair

Health Services Restructuring Commission

12^th Floor

56 Wellesley Street West

Toronto, Ontario

M5S 2S3

Tel: (416) 327-5919

FAX: (416) 327-5689

To: Sudbury General Hospital

700 Paris Street

Sudbury, ON P3E 3B5

Health Services Restructuring Commission

ADVICE TO THE MINISTER OF HEALTH CONCERNING SUDBURY GENERAL HOSPITAL

1. The funding allocation to the hospital be adjusted to reflect the clinical and administrative efficiencies that will be achieved by the hospital and program transfers. Based on the latest available clinical and service data for 1994/95 the estimated adjustments in the costs of operation are:

• 1994/95 total expenses $56,536,655
• less 1996/97 operating funding reductions of $(1,830,500)

3. Consider adjustments to the amounts noted here to take into account non-Ministry of Health revenue and inflationary pressures that Sudbury General Hospital may experience, and;

Advise the Health Services Restructuring Commission of these considerations.

4. The funding allocation for programs to be transferred between hospitals has been calculated based on the following principles:

• the funding reduction to the hospital that is transferring the program should be based on the actual costs for the program
• the funding increase to the hospital receiving the program should be at the lower of the actual or expected cost for such programs adjusted for the hospital's case load
• the funding reduction or increase to the hospital for the transfer or increase of the chronic care, rehabilitation or mental health programs should be based on the actual costs at the hospital

• February 28, 1997 concerning the plan for governance changes
• May 31, 1997 concerning the Laboratory and Pathology Consolidation plan
• May 31, 1997 concerning the Human Resource Adjustment plan

_______________ Chair

Health Services Restructuring Commission

12^th Floor

56 Wellesley Street West

Toronto, Ontario

M5S 2S3

Tel: (416) 327-5919

FAX: (416) 327-5689

To: The Honourable Dave Johnson

Minister of Health

10^th Floor, Hepburn Block

Toronto, ON M7A 2C4

Health Services Restructuring Commission

DIRECTIONS

THE HEALTH SERVICES RESTRUCTURING COMMISSION HAVING ISSUED THE NOTICES OF INTENTION ON SEPTEMBER 30, 1996 AND HAVING CONSIDERED THE REPRESENTATIONS RECEIVED IN RESPONSE DIRECTS the board of directors of the Sudbury Memorial Hospital to undertake the following:

1. Led by a facilitator appointed by the Commission, develop a plan, in conjunction with the Laurentian Hospital, and Sudbury General Hospital, to create a new hospital corporation (the "new Sudbury Regional Hospital Corporation") to assume the governance and provision of all hospital based acute, chronic and rehabilitation services and programs in the Sudbury area. The governance structure must be representative of the communities served and have regard to the demographic, cultural, economic, geographic, ethnic, religious and social characteristics of the Sudbury and the Northeast Region of Ontario. The plan must provide for the transfer of hospital assets to the new Sudbury Regional Hospital Corporation. The plan must be submitted to the Health Services Restructuring Commission and the Ministry of Health by no later than January 31, 1997. The new Sudbury Regional Hospital Corporation shall be created no later than April 30, 1997.

2. The plan must address the unique status of hospital based mental health services and provide for the access, coordination, and funding of all hospital-based mental health services by the Sudbury Algoma Hospital/Network North as an interim step pending the outcome of the regional mental health plan.

3. The plan must provide for the transfer of hospital assets, no later than 30 days after the formation of the new Sudbury Regional Hospital Corporation or such date as the Health Services Restructuring Commission may direct, and recommend appropriate compensation to the extent that any assets to be transferred have not been paid for, directly or indirectly, by funds received from the Crown.

4. By January 31, 1997 pass a resolution that would prohibit the transfer of any funds and assets from the hospital corporation to any related hospital foundation or any other person without a further direction from the Health Services Restructuring Commission.

5. Pending creation of the new Sudbury Regional Hospital Corporation, work in conjunction with Laurentian Hospital, Sudbury Algoma Hospital and the Sudbury General Hospital and representatives of affected employees to submit to the Health Services Restructuring Committee and the Ministry of Health a human resources adjustment plan by April 30, 1997 that will address the impact of the implementation of the directions on the hospital's employees, including the transfer of programs to other hospitals, the reduction in utilization rate, the reduction in the number of beds and the consolidation of acute services.

6. Pending creation of the new Sudbury Regional Hospital Corporation, work in conjunction with the Sudbury General Hospital, the Laurentian Hospital and the Sudbury Algoma Hospital to submit to the Health Services Restructuring Commission by April 30, 1997 a plan to maximize the efficiency of the delivery of administrative services, support services and diagnostic services (e.g. laboratory services) of the hospitals and other health care facilities in Northeastern Ontario. The plan must address alternative services delivery systems, including services that can be provided by the private sector.

7. Pending creation of the new Sudbury Regional Hospital Corporation, work in conjunction with the Sudbury General Hospital, the Laurentian Hospital and the Sudbury Algoma Hospital to develop and submit to the Health Services Restructuring Commission and the Ministry of Health by April 30, 1997 a plan for the hospital laboratory and pathology services in the Sudbury hospitals that is consistent with the directions of the Ministry of Health's Laboratory Reform Strategy. As part of the plan, consolidate all hospital based laboratory services in a single site with one program for all hospital based laboratory and pathology services.

8. Submit to the Ministry of Health and the Health Services Restructuring Commission quarterly progress reports on the status of the implementation of the above directions, including a progress report on the implementation of the human resources adjustment plan. The first report is to be received at the latest by April 30, 1997 for the period ending March 31, 1997.

The Health Services Restructuring Commission further directs the Sudbury Memorial Hospital to take all proceedings, corporate and otherwise, to implement such directions.

Accompanying these Directions are:

1. Copies of the Directions to the other hospitals in the Regional Municipality of Sudbury including the draft notice to the new Sudbury Regional Hospital Corporation;

2. Copies of the recommendations the Health Services Restructuring Commission has provided to the Minister of Health of Ontario;

3. A copy of the Sudbury Health Services Restructuring report (December 1996) prepared by the Health Services Restructuring Commission.

DATED at Toronto this 16^th day of December, 1996

_______________ Chair

Health Services Restructuring Commission

12^th Floor

56 Wellesley Street West

Toronto, Ontario

M5S 2S3

Tel: (416) 327-5919

FAX: (416) 327-5689

To: Sudbury Memorial Hospital

865 Regent Street South

Sudbury, ON P3E 3Y9

Health Services Restructuring Commission

ADVICE TO THE MINISTER OF HEALTH CONCERNING SUDBURY MEMORIAL HOSPITAL

1. The funding allocation to the hospital be adjusted to reflect the clinical and administrative efficiencies that will be achieved by the hospital and program transfers. Based on the latest available clinical and service data for 1994/95 the estimated adjustments in the costs of operation are:

• 1994/95 total expenses $46,579,275
• less 1996/97 operating funding reductions of $(1,332,600)

3. Consider adjustments to the amounts noted here to take into account the timing of the transfer, non-Ministry of Health revenue and inflationary pressures that Sudbury Memorial Hospital may experience, and;

Advise the Health Services Restructuring Commission of these considerations.

4. The funding allocation for programs to be transferred between hospitals has been calculated based on the following principles:

• the funding reduction to the hospital that is transferring the program should be based on the actual costs for the program
• the funding increase to the hospital receiving the program should be at the lower of the actual or expected cost for such programs adjusted for the hospital's case load
• the funding reduction or increase to the hospital for the transfer or increase of the chronic care rehabilitation, and mental health programs should be based on the actual costs at the hospital.

• February 28, 1997 concerning the plan for governance changes
• May 31, 1997 concerning the Laboratory and Pathology Consolidation plan
• May 31, 1997 concerning the Human Resources Adjustment plan

_______________ Chair

Health Services Restructuring Commission

12^th Floor

56 Wellesley Street West

Toronto, Ontario

M5S 2S3

Tel: (416) 327-5919

FAX: (416) 327-5689

To: The Honourable Dave Johnson

Minister of Health

10^th Floor, Hepburn Block

Toronto, ON M7A 2C4

Health Services Restructuring Commission

DIRECTIONS

THE HEALTH SERVICES RESTRUCTURING COMMISSION HAVING ISSUED THE NOTICES OF INTENTION TO ISSUE DIRECTIONS ON SEPTEMBER 30, 1996 AND HAVING CONSIDERED THE REPRESENTATIONS RECEIVED IN RESPONSE DIRECTS the board of directors of the Laurentian Hospital to undertake the following:

1. Led by a facilitator appointed by the Commission, develop a plan, in conjunction with the Sudbury Memorial Hospital and Sudbury General Hospital, to create a new hospital corporation (the "new Sudbury Regional Hospital Corporation") to assume the governance and provision of all hospital based acute, chronic and rehabilitation services and programs in the Sudbury area. The governance structure must be representative of the communities served and have regard to the demographic, cultural, economic, geographic, ethnic, religious and social characteristics of the Sudbury and the Northeast Region of Ontario. The plan must provide for the transfer of hospital assets to the new Sudbury Regional Hospital Corporation. The plan must be submitted to the Health Services Restructuring Commission and the Ministry of Health by no later than January 31, 1997. The new Sudbury Regional Hospital Corporation shall be created no later than April 30, 1997.

2. The plan must address the unique status of hospital based mental health services and provide for the access, coordination, and funding of all hospital-based mental health services by the Sudbury Algoma Hospital/Network North as an interim step pending the outcome of the regional mental health plan.

3. The plan must provide for the transfer of hospital assets, no later than 30 days after the formation of the new Sudbury Regional Hospital Corporation or such date as the Health Services Restructuring Commission may direct, and recommend appropriate compensation to the extent that any assets to be transferred have not been paid for, directly or indirectly, by funds received from the Crown.

4. By January 31, 1997 pass a resolution that would prohibit the transfer of any funds and assets from the hospital corporation to any related hospital foundation or any other person without a further direction from the Health Services Restructuring Commission.

5. Pending creation of the new Sudbury Regional Hospital Corporation, work in conjunction with Sudbury Memorial Hospital, Sudbury Algoma Hospital and the Sudbury General Hospital and representatives of affected employees to submit to the Health Services Restructuring Committee and the Ministry of Health a human resources adjustment plan by April 30, 1997 that will address the impact of the implementation of the directions on the hospital's employees, including the transfer of programs to other hospitals, the reduction in utilization rate, the reduction in the number of beds and the consolidation of acute services.

6. Pending creation of the new Sudbury Regional Hospital Corporation, work in conjunction with the Sudbury General Hospital, the Sudbury Memorial Hospital and the Sudbury Algoma Hospital to submit to the Health Services Restructuring Commission by April 30, 1997 a plan to maximize the efficiency of the delivery of administrative services, support services and diagnostic services (e.g. laboratory services) of the hospitals and other health care facilities in Northeastern Ontario. The plan must address alternative services delivery systems, including services that can be provided by the private sector.

7. Pending creation of the new Sudbury Regional Hospital Corporation, work in conjunction with the Sudbury General Hospital, the Sudbury Memorial Hospital and the Sudbury Algoma Hospital to develop and submit to the Health Services Restructuring Commission and the Ministry of Health by April 30, 1997 a plan for the hospital laboratory and pathology services in the Sudbury hospitals that is consistent with the directions of the Ministry of Health's Laboratory Reform Strategy. As part of the plan, consolidate all hospital based laboratory services in a single site with one program for all hospital based laboratory and pathology services.

8. Pending creation of the new Sudbury Regional Hospital Corporation, work in conjunction with the funding agencies (Ministry of Health, Ministry of Community and Social Service, Ministry of Education), the Sudbury Manitoulin District Health Council and the Children's Treatment Centre Committee to develop and submit to the Health Services Restructuring Commission and the Ministry of Health, by March 31, 1997, a plan which looks at the feasibility of moving the Children's Treatment Centre (CTC) to the Ramsey site, possibly located in a separate facility. This plan will include:

• a short focused review of the existing needs assessment/Master Program which was undertaken in 1989 to ensure that the proposed CTC scope is still appropriate
• the operating savings that would be achieved from the relocation estimated reinvestments required for the relocated program based on the size and scope required for the region

The Health Services Restructuring Commission further directs the Laurentian Hospital to take all proceedings, corporate and otherwise, to implement such directions.

Accompanying these Directions are:

1. Copies of the Directions to the other hospitals in the Regional Municipality of Sudbury including the draft notice to the new Sudbury Regional Hospital Corporation;

2. Copies of the recommendations the Health Services Restructuring Commission has provided to the Minister of Health of Ontario;

3. A copy of the Sudbury Health Services Restructuring Report (December 1996) prepared by the Health Services Restructuring Commission.

DATED at Toronto this 16^th day of December, 1996

_______________ Chair

Health Services Restructuring Commission

12^th Floor

56 Wellesley Street West

Toronto, Ontario

M5S 2S3

Tel: (416) 327-5919

FAX: (416) 327-5689

To: Laurentian Hospital

41 Ramsey Lake Road

Sudbury, ON P3E 5J1

Health Services Restructuring Commission

ADVICE TO THE MINISTER OF HEALTH CONCERNING LAURENTIAN HOSPITAL

1. The funding allocation to the hospital be adjusted to reflect the clinical and administrative efficiencies that will be achieved by the hospital and program transfers. Based on the latest available clinical and service data for 1994/95 the estimated adjustments in the costs of operation are:

• 1994/95 total expenses $60,500,442
• less 1996/97 operating funding reductions of $(1,492,400 )

3. Consider adjustments to the amounts noted here to take into account the timing of this transfer, non-Ministry of Health revenue and inflationary pressures that Laurentian Hospital may experience, and;

Advise the Health Services Restructuring Commission of these considerations.

4. The funding allocation for programs to be transferred between hospitals has been calculated based on the following principles:

• the funding reduction to the hospital that is transferring the program should be based on the actual costs for the program
• the funding increase to the hospital receiving the program should be at the lesser of the actual or expected cost for such programs adjusted for the hospital's case load
• the funding reduction or increase to the hospital for the transfer of the chronic care rehabilitation or mental health programs should be based on the actual costs at the hospital

• February 28, 1997 concerning the plan for governance changes
• May 31, 1997 concerning the Laboratory and Pathology consolidation plan
• April 30, 1997 concerning the plan for relocating the Children's Treatment Centre to the Ramsey site
• May 31, 1997 concerning the Human Resource Adjustment plan

_______________ Chair

Health Services Restructuring Commission

12^th Floor

56 Wellesley Street West

Toronto, Ontario

M5S 2S3

Tel: (416) 327-5919

FAX: (416) 327-5689

To: The Honourable Dave Johnson

Minister of Health

10^th Floor, Hepburn Block

Toronto, ON M7A 2C4

Health Services Restructuring Commission

DIRECTIONS

THE HEALTH SERVICES RESTRUCTURING COMMISSION HAVING ISSUED THE NOTICES OF INTENTION TO ISSUE DIRECTIONS ON SEPTEMBER 30, 1996, AND HAVING CONSIDERED THE REPRESENTATIONS RECEIVED IN RESPONSE DIRECTS the Board of Directors of the Sudbury Algoma Hospital to undertake the following:

1. Work in conjunction with the Sudbury Memorial Hospital, Laurentian Hospital and Sudbury General Hospital in their planning for the new Sudbury Regional Hospital Corporation to address the access, coordination and funding of hospital-based mental health services.

2. Participate with the Northeast Region Mental Health Advisory Committee of the district health councils of northeastern Ontario in the development of a plan, in conjunction with the public hospitals and the provincial psychiatric hospital, the community based mental health agencies, and consumer/survivor and community representatives. In that plan consideration must be made to a governance structure for all hospital based mental health services, including all hospital based acute, chronic and rehabilitation psychiatric services and programs. The governance structure must be representative of the communities served and that have regard to the north east region's demographic, cultural, economic, geographic, ethnic, religious and social characteristics.

3. The plan shall also include:

I) the number of beds, supportive housing, community mental health services required at the provincial planning ratios of 30 beds per 100,000 population and related planning ratios;

II) the appropriate sizing and siting of all inpatient and outpatient mental health services among community public and provincial hospitals;

III) the estimated savings from the hospital sector related to:

a) reducing of inpatient clinical activity from current levels to planned levels;

b) consolidation and reduction of support services;

c) consolidation and reduction of administration;

d) improvement in efficiency (i.e., equity) in the provision of services and programs;

e) the transfer of clinical activity between facilities.

IV) the estimated reinvestment requirements in:

a) supportive housing

b) crisis intervention

c) community-based services

d) primary care and prevention

e) physician services

V) the additional physician and other professional manpower requirements by community

VI) the establishment of an regional agency and governance structure to plan for and purchase mental health services from a variety of providers but not deliver services directly.

4. The Mental Health plan shall be submitted to the Health Services Restructuring Commission and the Ministry of Health by no later than March 31, 1997.

5. Pending creation of the new Sudbury Regional Hospital Corporation, work in conjunction with Sudbury General Hospital, Laurentian Hospital and the Sudbury Memorial Hospital and representatives of affected employees to submit to the Health Services Restructuring Commission and the Ministry of Health by April 30, 1997, a human resources adjustment plan that will address the impact of the implementation of the above directions on the hospital's employees, including the transfer of programs to other hospitals, the reduction in utilization rate, the reduction in the number of beds and the consolidation of acute services.

6. Pending creation of the new Sudbury Regional Hospital Corporation, work in conjunction with Sudbury Memorial Hospital, the Sudbury General Hospital and the Laurentian Hospital to submit to the Health Services Restructuring Commission by April 30, 1997 a plan to maximize the efficiency of the delivery of administrative services, support services and diagnostic services (e.g. laboratory services) of the hospitals and other health care facilities in Northeastern Ontario. The plan must address alternative services delivery systems, including services that can be provided by the private sector.

7. Pending creation of the new Sudbury Regional Hospital Corporation, work in conjunction with Sudbury Memorial Hospital, the Sudbury General Hospital and the Laurentian Hospital to develop and submit to the Ministry of Health and the Health Services Restructuring Commission by April 30, 1997 a plan for the hospital laboratory and pathology services in the Sudbury hospitals that is consistent with the directions of the Ministry of Health's Laboratory Reform Strategy. As part of the plan, consolidate all hospital based laboratory services in a single site with one program for all hospital based laboratory and pathology services.

8. Submit to the Ministry of Health and the Health Services Restructuring Commission quarterly progress reports on the status of the implementation of the above directions, including a progress report on the implementation of the human resources adjustment plan. The first report is to be received at the latest by April 30, 1997 for the period ending March 31, 1997.

9. Operate 27 adult psychogeriatric/rehabilitation beds and 12 adolescent mental health beds at the hospital and all related ambulatory programs.

The Health Services Restructuring Commission further directs the Sudbury Algoma Hospital to take all proceedings, corporate and otherwise, to implement such directions.

Accompanying these Directions are:

1. Copies of the Directions to the other hospitals in the Regional Municipality of Sudbury including the draft notice to the new Sudbury Regional Hospital Corporation;

2. Copies of the recommendations the Health Services Restructuring Commission has provided to the Minister of Health of Ontario;

3. A copy of the Sudbury Health Service Restructuring Report (December 1996) prepared by the Health Services Restructuring Commission.

DATED at Toronto this 16^th day of December, 1996

_______________ Chair

Health Services Restructuring Commission

12^th Floor

56 Wellesley Street West

Toronto, Ontario

M5S 2S3

Tel: (416) 327-5919

FAX: (416) 327-5689

To: Sudbury Algoma Hospital

680 Kirkwood Drive

Sudbury, ON P3E 1X3

Health Services Restructuring Commission

ADVICE TO THE MINISTER OF HEALTH CONCERNING SUDBURY ALGOMA HOSPITAL

1. Based on the latest available clinical and service data for 1994/95 the estimated savings in the costs of operation that would be available for reinvestment in the northeast region mental health plan are:

Reduction in Adult Mental Health Beds

From 44 to 27 $(3,176,040)

Support services savings $(215,877)

Administrative savings $(893,607)

Total potential savings that would

be available for reinvestment in

the Mental Health Plan ($4,285,524)

2. The Sudbury Algoma should be approved for up to $0.87 million in capital to upgrade its facilities

3. Respond to Sudbury Algoma Hospital by:

• April 30, 1997 concerning the Mental Health Plan
• May 31, 1997 concerning the plan to consolidate Laboratory and Pathology services
• May 31, 1997 concerning the Human Resources Adjustment plan

_______________ Chair

Health Services Restructuring Commission

12^th Floor

56 Wellesley Street West

Toronto, Ontario

M5S 2S3

Tel: (416) 327-5919

FAX: (416) 327-5689

To: The Honourable Dave Johnson

Minister of Health

10^th Floor, Hepburn Block

Toronto, ON M7A 2C4

DRAFT

Health Services Restructuring Commission

DRAFT NOTICE OF INTENTION TO ISSUE DIRECTIONS TO THE SUDBURY REGIONAL HOSPITAL CORPORATION:

1. Implement a plan to consolidate all acute hospital services on the Ramsey site and to close the Paris and Regent sites no later than April 30, 1999.

2. Transfer from the Paris and Regent sites all acute, chronic and rehabilitation hospital programs operated on those sites to the Ramsey site.

3. Implement a plan to achieve the inpatient acute services interim target of 697 patient days/1000 population by April 30, 1998 and the utilization target of 540 patient days/1000 population by April 30, 1999.

4. Implement a plan to operate a maximum number of 384 acute care beds, including 345 medical/surgical beds, 39 acute mental health beds for adult patients, and 100 chronic beds, and 31 rehabilitation beds, by April 30, 1999.

5. Establish by January 31, 1998 based on an assessment of the most cost effective options, either at the new Sudbury Regional Hospital Corporation or through arrangements with providers of long term care services, a transitional care program of 75 beds for patients who no longer require acute hospital care and either require additional convalescence or are waiting placement in an alternative level of care setting.

6. Submit to the Minister of Health for approval by April 30, 1998 the hospital board's plan for the decommissioning of the Paris and Regent sites.

7. Submit to the Ministry of Health and the Health Services Restructuring Commission quarterly progress reports on the status of the implementation of the above directions, including a progress report on the implementation of the human resources adjustment plan. The first report is to be received at the latest by July 31, 1997 for the period ending June 30, 1997.

The Health Services Restructuring Commission further directs the new Sudbury Regional Hospital Corporation to take all proceedings, corporate and otherwise, to implement such directions.

Accompanying this Notice are:

1. Copies of the Directions to the other hospitals in the Regional Municipality of Sudbury;

2. Copies of the recommendations the Health Services Restructuring Commission has provided to the Minister of Health of Ontario;

3. A copy of the Sudbury Health Services Restructuring Report (December 1996) prepared by the Health Services Restructuring Commission.

DATED at Toronto this 30^th day of April , 1997

_______________ Chair

Health Services Restructuring Commission

12^th Floor

56 Wellesley Street West

Toronto, Ontario

M5S 2S3

Tel: (416) 327-5919

FAX: (416) 327-5689

Date of Service of this Notice May 1, 1997

To: New Sudbury Regional Hospital Corporation

DRAFT

Health Services Restructuring Commission

DRAFT NOTICE OF ADVICE TO THE MINISTER OF HEALTH CONCERNING THE NEW SUDBURY REGIONAL HOSPITAL CORPORATION

1. The funding allocation to the hospital should be adjusted to reflect the clinical and administrative efficiencies that will be achieved by the hospital and program transfers. Based on the latest available clinical and service data for 1994/95 the estimated adjustments in the costs of operation are:

1994/95 total expenses of the Sudbury General, Sudbury Memorial and Laurentian hospitals	$163,616,372
Less 1996/97 operating funding reductions for the hospitals	$ (4,655,500)
Transferred to New Sudbury Regional Hospital Corporation	$158,960,872
Less Savings from Program Transfers Sudbury General Hospital	$(6,118,835)
Sudbury Memorial Hospital	$(7,446,054)
Laurentian Hospital	-
Less remaining Improvements in clinical efficiencies	$(19,314,770)1
Less support service savings	$(5,384,897)
Less administrative savings	$(4,365,842)
Plus reinvestment for 11 acute beds	$1,936,829
Total Budget	$118,267,303

¹ Clinical efficiencies have been reduced by the amount of the 1996/97 base reduction of $4,655,500. These adjustments in the costs of operation are estimates and along with the timing of implementation will be subject to review. Further review may result in adjustments recognizing factors relating to achievable savings attributable to reductions in length of stay, or other variables.

2. Reductions in operating costs resulting from restructuring should be applied against the application of reductions in Ministry of Health operating funds in 1997/98 and 1998/99.

3. Consider adjustments to the amounts noted here to take into account the timing of the transfers, non-Ministry of Health revenue and inflationary pressures that New Sudbury Regional Hospital Corporation may experience, and;

Advise the Health Services Restructuring Commission of these considerations.

4. The funding allocation for programs to be transferred between hospitals has been calculated based on the following principles:

• the funding reduction to the hospital that is transferring the program should be based on the actual costs for the program
• the funding increase to the hospital receiving the program should be at the lesser of the actual or the expected cost for such programs adjusted for the hospital's case load
• the funding reduction to the hospital for the transfer of the chronic care program should be based on the actual costs at the hospital

• May 31, 1998 concerning the plan to decommission the Paris and Regent sites.

DATED at Toronto this 16^th day of December, 1996

_______________ Chair

Health Services Restructuring Commission

12^th Floor

56 Wellesley Street West

Toronto, Ontario

M5S 2S3

Tel: (416) 327-5919

FAX: (416) 327-5689

To: The Honourable Dave Johnson

Minister of Health

10^th Floor, Hepburn Block

Toronto, ON M7A 2C4

Restructuring Report attached
News Release attached
Backgrounder attached
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