Fact Sheet
Metropolitan Toronto Reinvestment and Savings, July 23, 1997

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Recommended reinvestment in services

Reinvestment Summary

	HSRC Report March 1997	HSRC Report July 1997
Home Care	$7.3 million	$ 28 million
Long-Term Care	$25 million	minimum of $97 million
Sub-Acute Care	HSRC identified $18.8 to $21.7 million would be needed to address transitional care of 512 beds	$26 to $32 million
MRI units	$5 million	$ 5 million
Mental Health	N/A	$1.7 million
TOTAL	$56.1 to $59 million	$158 to $164 million

Recommended reinvestment in capital

Acute Care Hospitals

	Construction, Furniture and Equipment Costs *
Hospital	March 1997	JULY 1997 Report
The Toronto Hospital: Western Division	$8.0 million	$8.0 million
St. Michael's Hospital	$15.3 mil	$ 23.5 mil
Bayview Hospital Corporation	$41.9 mil	$43.0 mil
St. Joseph's Health Centre	$5.7 mil	$7.0 mil
The Queensway Mississauga Hospital Corporation: Queensway site Mississauga site	$3.8 million $13.1 mil	$ 3.8 mil TBD **
Humber River Regional: Finch Ave. site Church St. site	$30.6 mil $20.5 mil	$37.9 mil $17.5 mil
North York Branson Hospital site	0	$4.1 mil
North York General Hospital	$13.0 mil	$20.7 mil
Centenary Health Centre	$0.9 mil	$ 1.2 mil
Scarborough General Hospital	$2.6 mil	$ 2.6 mil
Toronto East General and Orthopaedic Hospital	$2.5 mil	$ 6.5 mil
The Donwood Institute	$0.14 mil	$ 0
Total	$158.1 million	$175.8 million

* Includes ancillary and site development costs.
** Capital costs for the Mississauga site will be determined in the HSRC's review of the rest of the GTA.

Capital Reinvestment for Rehabilitation and Complex Continuing Care*

Hospital	Capital Costs
West Park Hospital	$2.5 million
Research Institute of Toronto: University Ave. site	$ 2.4 million
Toronto East General and Orthopaedic Hospital	$6.1 million
Total	$ 11 million

* Complex continuing care includes palliative care and respite.

Estimated savings

Summary Table of Total Acute Care Expenses and Savings

	March 1997 Report	July 1997 Report
1995/96 Gross Expenses/Net Expenses ¹	$2,509,219,916	$2,352,906,147
Clinical Efficiencies	(113,045,844)	(109,155,279)
Program Transfers	(6,429,528)	(32,610,268)
Support Services Efficiencies	(57,730,882)	(53,730,929)
Administrative Efficiencies	(190,300,622)	(150,045,943)
Site Closure Expenses	(20,632,097)	(15,102,609)
Program Consolidation	(9,604,527)	-
Change in Selected Expenses	-	(15,458,779)
TOTAL SAVINGS	(397,743,500)	(376,103,807)
REVISED EXPENSES	2,111,476,416	1,976,802,340

¹ Gross expenses from MIS Trial Balance used in March Report, Net Expenses from OCDM used in July Report

Mental Health Savings Estimates

The reduction in inpatient mental health in Metro Toronto provides savings of $1,764,471. This savings will be available for reinvestment in community-based mental health services.

Rehabilitation Savings Estimates

Summary of Total Rehabilitation Costs and Savings

NET EXPENSES	$104,494,251
Program Transfers	(13,343,309)
Allied Health Adjustment	4,113,516
Administrative Efficiencies	(7,766,553)
Change in Selected Expenses	(441,750)
Site Closure Expenses	(1,783,036)
COST OF RECONFIGURED SYSTEM	85,273,118
TOTAL SAVINGS	(19,221,133) (-18.4 %)

Complex Continuing Care Savings Estimates

Summary of Total Complex Continuing Care Costs and Savings

NET EXPENSES	$220,797,310
Program Transfers	(61,988,808)
Resource Intensity Adjustment	14,624,107
Administrative Efficiencies	(16,762,745)
Change in Selected Expenses	5,798,374
Site Closure Expenses	(8,204,937)
COST OF RECONFIGURED SYSTEM	147,317,171
TOTAL SAVINGS	(73,662,139) (-33.3%)

The HSRC intends to advise the Minister of Health to reinvest these savings and to provide additional funding to add long-term care beds in Metro Toronto (see Section IV).

Fact Sheet
Metropolitan Toronto Summary of Restructuring Directions by Hospital, July 23, 1997

ACUTE CARE HOSPITALS
Hospital	Status of Physical Facility	Health Services Restructuring Commission Decisions	Status of Corporate Entity / Governance Changes
*- Central Hospitals -*
Doctors Hospital	Close	Transfer and fully integrate all inpatient & ambulatory programs to The Toronto Hospital (TTH), Western Division	Board to act in an advisory capacity to TTH for 2 years. Three members of the Doctors Hospital to be appointed to the TTH Board for a 3 year term. Chair of Doctors Hospital to be one of the 3 members and will serve as a vice-chair of TTH's Board.
Hospital for Sick Children	Retain	Lead the development and work of the Child Health Network Participate in Provincial Paediatric Task Force	No change.
Mount Sinai Hospital	Retain	Joint committee with The Toronto Hospital, Princess Margaret Hospital and the U of T to make binding decisions on program realignment across the University Avenue Hospitals (including the Western Division of the Toronto Hospital)	No change.
Orthopaedic and Arthritic Hospital	Close	Integrate clinical programs with those of Women's College Hospital and Sunnybrook Health Science Centre	Amalgamate with Sunnybrook Health Science Centre and Women's College Hospital.
Princess Margaret Hospital/ Ontario Cancer Institute	Retain	Joint committee with The Toronto Hospital, Mount Sinai and the University of Toronto to make binding decisions on program realignment across the University Avenue Hospitals (including the Western Division of the Toronto Hospital)	Have voted to merge with The Toronto Hospital by September 1997.
Sunnybrook Health Science Centre	Retain	Integrate clinical programs with those of Women's College Hospital and Orthopaedic & Arthritic Hospital Assume regional burn unit role, absorbing the programs now sited at Scarborough General and Wellesley Central hospitals	Amalgamate with Women's College Hospital and Orthopaedic and Arthritic Hospital.
St. Michael's Hospital	Retain	Absorb most programs from Wellesley Central Hospital, except burn, dialysis and specified ambulatory care services Assume the operation & management of the programs and services of the Wellesley Central Hospital Develop a plan with Wellesley Central Hospital to establish a new corporation (Sherbourne Hospital Corporation) to assume the ownership and governance of an ambulatory care centre at the Central site Develop a plan with the Sherbourne Hospital Corporation for the provision of services at the ambulatory care centre on the Central Hospital site Develop a plan to transfer the resources from Wellesley Central Hospital's dialysis program, excluding the Riverdale hospital and nocturnal dialysis programs Work with Mt. Sinai, The Toronto Hospital and the Wellesley Central re any program transfers to downtown facilities	Appoint one-third of the St. Michael's Hospital Board from nominees provided by the Wellesley Central Hospital for a 3- year period. Appoint one-third of the Board members to the Sherbourne Hospital Corporation.
Sherbourne Hospital Corporation	On the Central site	Develop a plan with St. Michael's Hospital for the provision of services at the ambulatory care centre on the Central site	This is a new hospital corporation. Board composed of one-third membership from St. Michael's, one-third from the Wellesley Central and one-third from the community for a 3-year period. Following the initial period, one-third of the Board will be appointed by St. Michael's and two-thirds from the broader community.
The Toronto Hospital General Division Western Division	Retain both sites	Integrate clinical programs from Doctors Hospital at the Western site Designate ambulatory/community multi-cultural health programs as priorities Joint committee with the University to develop a plan for Family Practice Clinical Teaching Unit at the Western linked with ambulatory care programs Joint committee with Mount Sinai, Princess Margaret Hospital and the University of Toronto to make binding decisions on program realignments across the University Ave. Hospitals (including the Western Division of the Toronto Hospital)	Appoint three members of the Doctors Hospital to the Board for a 3 year term. Chair of Doctors Hospital to be one of the 3 members and will serve as a vice-chair of TTH's Board. Create a standing committee of the board with a focus on strengthening ambulatory /community programs. Have voted to merge with the Ontario Cancer Institute/ Princess Margaret Hospital by September 1997.
Wellesley Central Hospital Wellesley Site Central Site	Close Wellesley Site Retain Central Site	Transfer burn unit to Sunnybrook Dialysis resources to be distributed to new programs at Humber River Regional, Scarborough General and York Central hospitals Develop a plan with St. Michael's Hospital to relinquish to St. Michael's the operation and management of the programs and services of the Wellesley Central Hospital Transfer most programs to St. Michael's Hospital and some to Toronto East General and Orthopaedic Hospital Develop a plan with St. Michael's Hospital to establish a new corporation (Sherbourne Hospital Corporation) to assume the ownership and governance of an ambulatory care centre at the Central site The Central site to provide AIDS/HIV ambulatory services and designated other primary/ secondary level ambulatory services of the Wellesley Central Hospital e.g., mental health, senior's health etc.	The Board will nominate members, to be appointed by St. Michael's for a 3 year term. Wellesley Central Hospital appointees will make up one-third of the St. Michael's Board. Appoint one-third of the Board members of the Sherbourne Hospital Corporation.
Women's College Hospital	Close	Integrate clinical programs with those of the Orthopaedic and Arthritic and Sunnybrook Health Science Centre The amalgamated corporation to make decisions concerning the siting of ambulatory women's health programs including the sexual assault treatment centre (to be located in downtown Toronto)	Amalgamate with Sunnybrook Health Science Centre and Orthopaedic and Arthritic Hospital into a new corporation.

- Southwest Hospitals -

Queensway General Hospital Convert to ambulatory care centre
Transfer clinical programs to The Mississauga Hospital, St. Joseph's Health Centre and the Etobicoke General Hospital
Provide ambulatory care programs at the Queensway site
Amalgamate with The Mississauga Hospital into one corporation.

The Mississauga Hospital Retain
Integrate with clinical programs at Queensway General Hospital
Amalgamate with Queensway General Hospital into one corporation.

St. Joseph's Health Centre Retain
Receive clinical programs from Queensway General Hospital and the Northwestern site of the Humber River Regional Hospital
Assume Level II paediatrics program regional referral role
Provide child/ adolescent mental health beds
Provide MRI services
No change.

- Northwest Hospitals -

Etobicoke General Hospital Retain
Receive some clinical programs from the Queensway General
No change.

Humber/ River Regional Hospital:
Humber site Retain
Integrate clinical programs from Northwestern site
Receive dialysis caseload from Wellesley Central Hospital
Provide MRI services
No change.

Humber River Regional Hospital:
York-Finch site Retain
Receive some clinical programs from North York Branson Hospital
Assume Level II paediatrics program regional referral role
Provide child/ adolescent mental health beds
No change.

Humber River Regional Hospital:
Northwestern site Close
Transfer programs to the Humber and York Finch sites, and some to St. Joseph's Health Centre
No change.

- North Hospitals -

North York Branson (NYB) Hospital Close as an inpatient acute care hospital
Convert to Ambulatory Care

Transfer operation and management to North York General (NYG) Hospital
Clinical program inpatient volumes to be redistributed to North York General Hospital, Humber/River Regional Hospital: York Finch site, and York Central Hospital
Cease to operate as a public hospital.
In a subsidiary capacity with North York General Hospital manage the ambulatory care centre at the Branson site.

North York General Hospital Retain
Integrate clinical programs from North York Branson Hospital
Assume Level II paediatrics program regional referral role
Provide child/ adolescent mental health beds
Provide MRI services
Develop and implement a plan whereby North York General Hospital contracts with the North York Branson Hospital or its owners to manage the North York Branson site
No change.

Salvation Army Scarborough Grace Hospital Retain
Joint East Metro Task Force with Scarborough General, Centenary Health Centre and Toronto East General and Orthopaedic hospitals, to make binding decisions on the realignment of clinical programs and services
No change.

- East Hospitals -

Centenary Health Centre Retain
Assume Level II paediatrics program regional referral role
Provide child/ adolescent mental health beds
Joint East Metro Task Force with Scarborough General, Salvation Army Scarborough Grace and Toronto East General and Orthopaedic hospitals, to make binding decisions on the realignment of clinical programs and services
No change

Scarborough General Hospital Retain
Transfer burn unit to the Sunnybrook Health Science Centre site
Receive some Wellesley Central Hospital dialysis program activity
Joint East Metro Task Force with Toronto East General and Orthopaedic, Centenary Health Centre and Salvation Army Scarborough Grace hospitals, to make binding decisions on the realignment of clinical programs and services
Provide MRI services
No change.

Toronto East General and Orthopaedic Hospital Retain
Assume Level II paediatrics program regional referral role
Provide child/ adolescent mental health beds
Joint East Metro Task Force with Scarborough General, Centenary Health Centre and Salvation Army Scarborough Grace hospitals, to make binding decisions on the realignment of clinical programs and services
Provide MRI services
Receive some clinical programs from the Wellesley Central Hospital
No change.

- Addictions Services and Mental Health -

Addiction Research Foundation Retain
Consolidate programs with Queen Street Mental Health Centre, The Clarke Institute of Psychiatry and The Donwood Institute
Create new corporation with Queen Street Mental Health Centre, The Clarke Institute of Psychiatry and The Donwood Institute.

Bellwood Health Services Inc. Retain
No further action pending outcome of discussions between the Ministry of Health and the Bellwood Health Services Inc. concerning scope of services and terms of licence
No change.

The Donwood Institute Retain
Consolidate programs with Queen Street Mental Health Centre, The Clarke Institute of Psychiatry and The Addiction Research Foundation
Create new corporation with Queen Street Mental Health Centre, The Clarke Institute of Psychiatry and The Addiction Research Foundation.

Queen Street Mental Health Centre Retain
With the concurrence of the Minister of Health consolidate programs with The Clarke Institute of Psychiatry, The Addiction Research Foundation and The Donwood Institute
With the concurrence of the Minister of Health create a new corporation with the Addiction Research Foundation, The Clarke Institute of Psychiatry and The Donwood Institute.

Clarke Institute of Psychiatry Retain
Consolidate programs with Queen Street Mental Health Centre, The Addiction Research Foundation and The Donwood Institute
Create new corporation with Queen Street Mental Health Centre, the Addiction Research Foundation and The Donwood Institute.

Summary of Restructuring Notices Concerning Rehabilitation and Complex Continuing Care by Hospital

Hospital	Status of Physical Facility	Health Services Restructuring Commission Notices	Status of Corporate Entity/ Governance Changes
CHRONIC CARE and REHABILITATION HOSPITALS
Baycrest Centre for Geriatric Care	Retain	Discontinue rehabilitation role Transfer rehab programs to West Park Hospital Continue complex continuing care role Maintain longer-term mental health beds	Retain corporate status.
Bloorview MacMillan Centre	Retain Review of site options	Continue paediatric continuing care role and rehabilitation role	Retain corporate status.
Dewson Hospital	Close	Discontinue chronic care role Advised to apply to Ministry of Health to provide long-term care services in a new facility	Advise Minister to revoke licence as private hospital and consider an application to provide long term care services in a new facility.
Lyndhurst Hospital	Retain	Continue role in spinal cord rehabilitation	Amalgamate with Rehabilitation Institute of Toronto and The Toronto Rehabilitation Centre.
Providence Centre	Retain	Continue complex continuing care role Continue rehabilitation role pending HSRC's review of rehabilitation services in the rest of the GTA	Retain Corporate status.
Rehabilitation Institute of Toronto ( R.I.T.): 1) Austin Terrace site (Hillcrest) 2) University Ave site (Queen Elizabeth) 3) Dunn Ave. site (Queen Elizabeth)	Close Austin Terrace site Retain University Ave. site Retain Dunn Ave. site	Austin Terrace site - transfer rehab programs to University Ave. site University Ave. site - absorb rehab programs from Austin Terrace & Riverdale Hospital Continue to provide complex continuing care on the Dunn Ave site only Rehabilitation Institute of Toronto is designated as a regional rehabilitation provider Provide leadership for Metro Toronto Rehabilitation Network	Amalgamate with Lyndhurst Hospital and The Toronto Rehabilitation Centre.
Riverdale Hospital	Close	Discontinue rehabilitation and chronic care role Transfer programs to Rehabilitation Institute of Toronto, University Ave. site and to St. John's Rehab Hospital Advised to apply to Ministry of Health to provide long-term care services in a new facility	Cease to operate as a public hospital by December 1999. Advise Minister to consider an application to provide long-term care services in a new facility.
Runnymede Chronic Care Hospital	Close	Discontinue chronic care role Advised to apply to Ministry of Health to provide long-term care services in a new facility	Cease to operate as a public hospital by December 1999. Advise Minister to consider an application to provide long-term care services in a new facility.
Salvation Army Toronto Grace Hospital	Close	Discontinue chronic care role Advised to apply to Ministry of Health to provide long-term care services in a new facility	Cease to operate as a public hospital by December 1999. Advise Minister to consider an application to provide long-term care services in a new facility.
St. Bernard's Hospital	Close	Discontinue rehabilitation role Transfer programs to St. John's Rehabilitation Hospital Contract with St. John's to provide services on St. Bernard's site	Cease to operate as a public hospital by December 1997 but enter into a contractual arrangement with St. John's Rehabilitation Hospital to continue to operate the programs and services at that site until they are transferred.
St. John's Rehabilitation Hospital	Retain	Designated as a regional rehabilitation provider Receive programs from St. Bernard's Hospital, and from Riverdale	Retain corporate status.
St. Joseph's Infirmary	Retain	Continue complex continuing care role	Retain corporate status.
Toronto Rehabilitation Centre	Retain	Continue outpatient rehabilitation role	Amalgamate with Rehab Institute of Toronto and Lyndhurst Hospital.
West Park Hospital	Retain	Designated as a regional rehabilitation provider Receive programs from Baycrest Centre Continue complex continuing care role	Retain corporate status.

Hospital	Status of Physical Facility	Health Services Restructuring Commission Notices	Status of Corporate Entity/ Governance Changes
ACUTE CARE HOSPITALS
Bayview Hospital Corporation	Retain	Continue to provide complex continuing care beds for the community provide rehabilitation beds	Retain corporate status.
Centenary Health Centre	Retain	Continue to provide complex continuing care beds for the community Continue to provide rehabilitation beds	Retain corporate status.
The Mississauga Queensway Hospital Corporation	Retain McCall wing of the Queensway site for complex continuing care	Continue to provide complex continuing care beds at the McCall wing of the Queensway site Provide short-term rehabilitation beds	New corporation through the amalgamation of The Mississauga Hospital and the Queensway General Hospital (see directions).
St. Joseph's Health Centre*	Retain	Discontinue chronic care role at Our Lady of Mercy Provide short-term rehabilitation beds	Retain corporate status.
Salvation Army Scarborough Grace Hospital*	Retain	Enhanced role in providing complex continuing care beds for the community maintain role in rehabilitation	Retain corporate status.
Scarborough General Hospital*	Retain	Discontinue the provision of chronic care beds Continue to provide rehabilitation beds	Retain corporate status.
Toronto East General Hospital and Orthopaedic Hospital*	Retain	Provide complex continuing care beds Provide short-term rehabilitation beds	Retain corporate status
The Toronto Hospital* St. Michael's Hospital* Etobicoke General Hospital* Humber River Regional Hospital*	Retain	Provide short-term rehabilitation beds	Retain corporate status.

* Also note reference to the hospital in the Summary of Restructuring Directions

Fact Sheet
Metropolitan Toronto Community and Teaching Hospitals, July 23, 1997

The Health Services Restructuring Commission (HSRC) recommends the following design of acute services in Metropolitan Toronto (management and governance changes from the March report are indicated in bold):

University Avenue

Mount Sinai Hospital, Princess Margaret Hospital and The Toronto Hospital, and the University of Toronto, will establish the Joint University Avenue Hospitals Task Force to decide on further consolidation of programs and services to maximize coordinated patient care and minimize duplication. The Task Force will consider obstetrics and gynecology services as a priority.

Orthopaedic and Arthritic Hospital, Women's College Hospital and Sunnybrook Health Science Centre

The Orthopaedic and Arthritic Hospital, Women's College Hospital and Sunnybrook Health Science Centre will amalgamate to form a new hospital corporation on the Bayview site. The Orthopaedic and Arthritic and Women's College hospital sites downtown will close.
The HSRC will appoint a facilitator, who, jointly with the three hospitals and the University will develop a plan for a new governance structure which will consist of the amalgamation of the three hospitals. Among other elements, the plan will:
provide for the creation of a new corporate structure that will govern the provision of hospital-based services to be located at the Bayview site and ambulatory care women's health programs, including the sexual assault centre, at a downtown Toronto site; and
provide that the new corporate structure reflect the gender balance of the community it serves.
The facilitator also will consider:
- the maintenance of a women's centered approach to the provision of health services and the development of programs focused on women's health.

Wellesley Central Hospital and St. Michael's Hospital

St. Michael's Hospital will assume operation and management of the programs and services of the Wellesley Central Hospital. The Central Hospital site will become an ambulatory care centre ("Sherbourne Hospital Corporation") with its own board. Management for the centre will be provided by St. Michael's Hospital. The Wellesley site will close.
Most of the inpatient programs from the Wellesley Central Hospital will be transferred to St. Michael's Hospital. The outpatient programs that do not require the support of an inpatient facility will be transferred to the Sherbourne Hospital Corporation.
On a one-time basis and for a period of three years, one-third of the Board of Directors of St. Michael's Hospital will be appointed from a list of nominees provided by the Board of Directors of Wellesley Central Hospital.
For the first 3-year period, the members of the first Board of Directors of the Sherbourne Hospital Corporation will be one-third appointed by the Wellesley Central Hospital, one-third by St. Michael's Hospital, and one-third from the broader community.

Doctors Hospital and The Toronto Hospital

Doctors Hospital will close and its services will be fully integrated into the Western Division of The Toronto Hospital. The board of the Doctors Hospital will act in an advisory capacity for two years to the board of The Toronto Hospital.
The governance structure of The Toronto Hospital will be representative of the community served, including that of the Doctors Hospital.
The Toronto Hospital board will develop a plan that designates ambulatory and community care as one of the hospitals' priority programs. A standing committee of the board will be created with a focus on preserving and strengthening the ambulatory and community-oriented programs provided by Doctors Hospital.
Three members of the Doctors Hospital board will sit on The Toronto Hospital board on a one-time basis for a 3-year period. The chair of the Doctors Hospital board will be one of the three members and will serve as a Vice Chair of The Toronto Hospital board for three years.
The Toronto Hospital will be required to submit a separate operating plan for the Doctors Hospital Comprehensive Ambulatory Care Program to the Ministry. A separate reporting mechanism will ensure that the Ministry monitors the level of activity and resources for this program, and its priority status within the hospital.
The Toronto Hospital and University of Toronto will establish a Family Practice Clinical Teaching Unit on the Western site in association with the Ambulatory Care Centre.

Queensway General Hospital and The Mississauga Hospital

The Queensway General Hospital will amalgamate with The Mississauga Hospital to form a single hospital corporation. The Queensway General site will provide ambulatory care services.

North York Branson Hospital

North York General will assume operation and management of the programs and services of North York Branson Hospital.
North York Branson site will become an ambulatory care centre to meet the health needs of the large elderly population it currently serves. The new centre will have a contractual relationship with the North York General Hospital.
The inpatient activity at North York Branson Hospital will be redistributed to North York General Hospital, Finch site of the Humber River Regional Hospital, and York Central Hospital.

Other community hospitals

The remaining community hospitals will, for the most part, retain their current mix of services. The burn programs at the Wellesley Central Hospital and Scarborough General Hospital will be transferred to the Bayview site.

Fact Sheet
Metropolitan Toronto Maternal Newborn and Child Health Services, July 23, 1997

The Health Services Restructuring Commission (HSRC) recommends creation of a regional system of neonatal and paediatric care to ensure that people receive the level of care appropriate to their needs as close to their home as possible. A regional system will ensure high quality of care supported by an optimal mass of expertise and services.

Level II Centres

The Commission has determined that the obstetrical programs in Metropolitan Toronto are of sufficient size and scope that all hospitals should provide Level II neonatal care.

The five designated Level II inpatient paediatric centres remain unchanged: North York General Hospital, Centenary Health Centre, Toronto East General Hospital, York-Finch site of the Humber River Regional Hospital, and St. Joseph's Health Centre.

Level III Centres

High-risk maternal and neonatal care will be provided at Mount Sinai Hospital and Bayview Hospital Corporation. The Hospital for Sick Children will continue to provide Level III neonatal and paediatric services.

Metropolitan Toronto Child Health Network

The Health Services Restructuring Commission recommends the creation of the Child Health Network to coordinate planning of child health services in Metro Toronto in the redesigned system.

The Hospital for Sick Children will lead the development and ongoing work of the network. Membership in the Child Health Network includes all providers of neonatal and paediatric services in Metro Toronto with representation from hospitals in the balance of the Greater Toronto Area.

Fact Sheet
Metropolitan Toronto Rehabilitation Services, July 23, 1997

Redistributing services

The Health Services Restructuring Commission (HSRC) review shows that there are sufficient beds in the GTA, however, a distribution problem exists. The rehabilitation beds in Metro Toronto will decrease while the rehabilitation beds will increase in the balance of the GTA. The same volume of services will be provided through a shift from providing service on a five-days-a-week basis to seven-days-a-week.

Management and governance

The HSRC issued preliminary recommendations (Notice of Intention to Issue Directions) regarding rehabilitation services in Metropolitan Toronto. The deadline for representations is Monday, September 15, 1997. The proposed restructuring of rehabilitation services in Metro Toronto is as follows:

Short term rehabilitation services will be redistributed among Metro's acute care hospitals.
St. John's Rehabilitation Hospital will be the regional centre in the north.
The Rehabilitation Institute of Toronto (RIT)-Queen Elizabeth Hospital site will be the regional centre in south/central Metro. RIT was formed as a result of the amalgamation of Queen Elizabeth Hospital and Hillcrest Hospital, with the Hillcrest site closing.
Riverdale Hospital will transfer most of its rehabilitation programs to the Rehabilitation Institute of Toronto.
West Park Hospital will be the regional centre in the west.
St. Bernard's Hospital will close and its programs transferred to St. John's Rehabilitation Hospital.
Baycrest Hospital will transfer its rehabilitation programs to West Park Hospital.
A regional centre will be designated in the eastern quadrant following a review of health services in Durham and York regions.
Bloorview MacMillan Centre will continue to serve as the regional facility for paediatric inpatient and outpatient rehabilitation and complex continuing care.
A new hospital corporation will be formed by the amalgamation of RIT, Lyndhurst Hospital and Toronto Rehabilitation Centre (Tri-Hospital Rehabilitation Corporation).

Metro-wide rehabilitation network

The Commission also recommends the creation of a Metro-wide rehabilitation network. Membership will include hospitals providing rehabilitation services, Community Care Access Centres and others. Leadership of the network will be provided by the new corporation created by the Tri-hospital Rehab Corporation. The mandate of the network includes improving coordination and accessibility to services, establishing linkages among providers, evaluating quality and accessibility indicators, and improving efficiency.

Short-Term Rehabilitation Beds Summary

Facility	Current Distribution of Rehabilitation Beds in Acute Hospitals	Proposed Distribution of Short Term Rehabilitation Beds by 2003
The Toronto Hospital	0	25
Mt. Sinai Hospital	28	10
St. Michael's Hospital	0	20
Bayview Hospital Corporation	0	20
St. Joseph's Health Centre	0	10
Mississauga-Queensway Hospital Corporation*	0	6
Etobicoke General Hospital	0	10
Humber River Regional Hospital	0	18
North York General Hospital	0	15
Scarborough General Hospital	37	14
Salvation Army Scarborough Grace Hospital	12	5
Centenary Health Centre	27	11
Toronto East General & Orthopaedic Hospital	0	12
Total	104	176

* These rehabilitation beds are associated with the activities at Queensway. The review of the GTA will further assess the beds required by the total Mississauga-Queenway Hospital Corporation.

Current and Projected Rehabilitation Beds

Facility*	Current Beds	1999	2003
Rehabilitation Institute of Toronto	202	202	160
Lyndhurst	79	65	60
Providence	39	+	+
West Park**	142	142	85
St. John's	185	185	120
Riverdale	170	0	0
Baycrest	32	0	0
St Bernard's	59	0	0
Bloorview MacMillan	55	55	55

* Ministry of Health, Inventory of Beds, 1996
** Current beds as of July 1996. Includes 10 Transition to Independent Living beds.
+ Total of 45 beds in east Metro. Siting to be confirmed following the review of the rest of the GTA.

Fact Sheet
Metropolitan Toronto Mental Health and Addiction Services, July 23, 1997

Management and governance

The Health Services Restructuring Commission (HSRC) recommends that the Clarke Institute of Psychiatry, Addiction Research Foundation, Donwood Institute, and with the concurrence of the Ministry of Health, Queen Street Mental Health Centre, amalgamate to form a new hospital corporation. This consolidation of clinical services, and education and research activities in mental health and addictions will lead to:

better critical mass of services and elimination of duplication;
a comprehensive and co-ordinated plan of action for advocacy, health promotion and prevention efforts; and
a provincial role in addiction and mental health research, education and policy development.

The Commission deferred its decision regarding closure of Bellwood Health Services Inc., a private hospital providing addiction services, pending the outcome of discussions between Bellwood and the Ministry about the scope of its services.

Planning guidelines

New planning guidelines developed will allow for a more gradual shift from hospital-based to community-based mental health services. The HSRC introduced interim planning targets which will ensure an orderly transition in achieving the longer term goal of 30 beds per 100,000 population. The interim guidelines are:

37 beds per 100,000 population by the year 2000, (includes 21 beds for acute mental health and 16 beds for longer term mental health);
35 beds per 100,000 population by the year 2003, (includes 21 beds for acute and 14 beds for longer term mental health).

Once appropriate community supports are in place, the Commission hopes that the longer-term goal of 30 mental health beds per 1,000 can be achieved.

The planning target for the year 2000 is used to determine the hospital building capacity and number of beds that will be needed. The planning target for the year 2003 supports the continued shift from institutional-based care to community-based care.

Regional agency to monitor transition

The extent to which mental health services can be de-institutionalized will depend on local circumstances based on population need and the availability of community-based services and supports. The Commission strongly believes that community-based services and supports must be in place before hospital beds are reduced.

The Commission recommends establishing the Metro Toronto Addictions and Mental Health Agency on an interim basis to manage the total envelope of funding and the implementation of restructuring of the mental health system. This agency will be able to adjust the mix of hospital and community-based services, and monitor the transition to ensure patients' needs are being met. It will work with the Child Health Network to assess service needs for children and adolescents.

Child and adolescent mental health services

The Commission recommends a total of 53 beds for child and adolescent mental health services in Metro Toronto (compared to 23 beds in the March report). This is an interim number, subject to review and assessment by the regional mental health agency.

Forensic services

The Commission confirms 43 forensic mental health beds currently operated at the Queen Street Mental Health Centre. In addition, the Commission advises the Ministry of Health to consult with authorities in the justice and correctional services on the need for additional forensic beds in Metro Toronto.

Inpatient Beds for Mental Health and Addiction Services for Metro Toronto*

Type of Services	Beds in Use 1996	HSRC Proposed Beds to 2003 March Report	HSRC Revised Beds to 2000	HSRC Revised Beds to 2003
ACUTE: Community & Teaching Clarke Institute	464 80 The Clarke's bed numbers include 20 regional beds.	382 70	430 79	444 79
Acute Subtotal	544	452	509	523
LONGER TERM: Queen Street Mental Health Centre	416 QSMHC's catchment includes Peel Region, Toronto, the boroughs of Etobicoke and York, and part of North York.	298 The HSRC's March report assumed that QSMHC would provide service for Peel Region (99 beds) and all of Metro Toronto (199) except for Scarborough (Whitby Mental Health Centre, was to provide half the required beds. Baycrest would continue to provide 20 beds for Metro).	321 This number includes the 271 beds required for Metro and 50 beds for patients treated at QSMHC that have no fixed address (NFA); the 123 beds required for Peel will be dealt with when the remainder of the GTA is reviewed.	287 This number includes the 237 beds required for Metro and 50 beds for patients with NFA; the 115 beds required for Peel will be dealt with when the remainder of the GTA is reviewed.
(catchment = Metro Toronto & Peel)
Whitby Mental Health Centre (beds for Metro Toronto Residents)	70	27	32	31
Baycrest Centre for Geriatric Care	20	20	20	20
Longer Term Subtotal	506	345	373	338
FORENSIC Queen Street - Medium Secure Clarke's Assessment Unit ( METFORS)	20 23	20 23	20 23	20 23
Forensic Subtotal	43	43	43	43
CHILD / ADOLESCENT- Acute Beds Sunnybrook Health Science Centre Hospital For Sick Children Level II hospitals with Paediatric Units	8 15	8 15	8 15 30	8 15 30
Child /Adolescent Subtotal	23	23	53	53
TOTAL	1116	863	978	957
ADDICTION - Inpatient beds The Donwood Institute Bellwood Health Services Inc.	47 12	59 0	47 12	47 12
Addiction Subtotal	59	59	59	59

* See Appendix C for mental health acute and longer-term bed distributions by facility.

Fact Sheet
Metropolitan Toronto Long Term Care, July 23, 1997

The Health Services Restructuring Commission (HSRC) considers the broad spectrum of long term care to include chronic care (HSRC to refer to chronic care as complex continuing care) hospitals, chronic care units in acute care hospitals, nursing homes, homes for the aged, and community-based services.

The reduction in complex continuing care beds must be viewed in the context of sizing the rest of the long term care system. The HSRC supports the gradual restructuring of long term care services over the next three to five years to allow for sufficient time for appropriate alternative services to be put in place to meet the care needs of the population.

Management and governance

The HSRC issued preliminary recommendations (Notice of Intention to Issue Directions) regarding long term care services in Metropolitan Toronto. Hospitals that received Notices in March received revised Notices. The deadline for representations is Monday, September 15, 1997.

There are 16 facilities (2,808 beds) that provide hospital-based long term care (complex continuing care) in Metropolitan Toronto. Long term care beds are located in 61 municipal and charitable homes for the aged, and 67 facilities provide services to supportive housing clients. Based on the proposed new guidelines, Metro Toronto has too many complex continuing care beds and not enough nursing home/homes for the aged beds.

Complex continuing care

The Commission recommends locating complex continuing care beds both in acute care hospitals and, freestanding facilities as follows:

Centenary Health Centre,
Salvation Army Scarborough Grace Hospital,
Toronto East General and Orthopaedic Hospital,
Bayview Hospital Corporation,
Mississauga Queensway Hospital - Queensway site,
Providence Centre,
Tri-hospital Rehabilitation Corporation - Dunn Avenue site,
Baycrest Centre for Geriatric Care,
West Park Hospital, and
St. Joseph's Infirmary.

The following facilities will not provide complex continuing care after 1999. They may choose to submit proposals or applications to the Minister of Health for the development of long term care services in new facilities:

Runnymede Chronic Care Hospital,
Toronto Salvation Army Grace Hospital,
Dewson Private Hospital, and
Riverdale Hospital.

The following sites would no longer provide complex continuing care services:

Our Lady of Mercy Pavilion of St. Joseph's Health Centre, and
Scarborough General Hospital.

Other Long Term Care "Places"

Based on the proposed planning guideline, Metro Toronto will need more 9,400 places by 2003:

5,207 long term care beds in nursing homes/homes for the aged, requiring $97 million in additional annual funding; and
4,181 places in supportive housing, long term home care, attendant care and adult day care.

Impact of the Proposed Planning Guidelines on the Distribution of Long Term Care Services in Metro Toronto

	Current beds/spaces 1997	Proposed beds/spaces to 2003	Change
	Current beds/spaces 1997	Proposed beds/spaces to 2003	#	%
Complex continuing care *	2,241	1,379	(862)	38% decrease
Long term care	11,916	17,123	5,207	44% increase
Supportive housing/long term home care	12,629	16,810	4,181	33% increase

* Excludes 340 veterans' beds at the Sunnybrook Health Science Centre.

Current and Proposed Complex Continuing Care Beds in Metro

Facility	Current	Proposed
Centenary Health Centre	81	81
Salvation Army Scarborough Grace	15	60
Toronto East General and Orthopaedic	0	75
Bayview Hospital Corp*	63	75
Mississauga Queensway Hospital Corp (Queensway site)	120	120
Providence Centre	238	212
Tri-Hospital Rehab Corp (Dunn Avenue site)	301	301
Baycrest Centre for Geriatric Care	245	245
West Park	175	175
St. Joseph's Infirmary	35	35
Runnymede	114	0
Toronto Salvation Army Grace	119	0
Dewson	31	0
Riverdale	466	0
Our Lady of Mercy Pavilion of the St. Joseph's Health Centre	123	0
Scarborough General	28	0
Total	2,154	1,379
Bloorview MacMillan**	87	20
Total	2,241	1,399

* Excludes the 340 veterans' beds.
** 20 day beds and 20 spaces

Fact Sheet
Metropolitan Toronto Human Resources, July 23, 1997

The Health Services Restructuring Commission acknowledges the significant impact restructuring will have on workers in the health care system.

In its March report, the Commission called for the appointment of a fact finder to advise the Commission on the best mechanism and approach to develop a human resources plan for the Metropolitan Toronto hospital system.

In May 1997, the Commission appointed Vic Pathe as fact finder and he submitted his report in mid-June. His recommendations to the Commission include:

A labour adjustment plan negotiated by all Metro hospitals and unions which is binding;
A Metro-wide plan that is as comprehensive as possible;
Local plans to deal with issues specific to a small number of hospitals and which are not dealt with Metro-wide;
A convenor be appointed to call the parties together and, if the parties choose, to serve as facilitator; and
The need for a jobs registry.

The Commission is encouraged by the positive response and support from hospitals and labour leaders for developing a human resources plan. On June 26, 1997, the Commission appointed Mr. Pathe as the convenor to help hospitals and employee groups develop a human resources adjustment plan in Metropolitan Toronto.

The Commission directs the following hospitals, with representatives of affected employee groups, to develop and begin implementation of a human resources plan:

all Metropolitan Toronto hospitals;
York Central Hospital and The Mississauga Hospital; and
Queen Street Mental Health Centre and Whitby Mental Health Centre (with agreement from the Minister of Health).

At a minimum, the human resources plan must include the following components:

the process for dealing with human resources issues common to all hospitals or clusters of hospitals;
a dispute resolution mechanism; and
the participation of the hospitals and employee representatives in the jobs registry.

The plan is to be submitted to the Minister of Health and the Commission by October 31, 1997.

Medical human resources plan

The Commission will appoint fact finders to advise it on the best mechanism and approach to develop a medical human resources adjustment plan for Metro Toronto, London and Ottawa. The fact finders are expected to complete their work by this fall. Representations received by the HSRC concerning the medical human resources adjustment plan will be forwarded to the fact finders once they are appointed. In the interim, the HSRC will accept representations from interested individuals and organizations until September 15, 1997.

Fact Sheet
Metropolitan Toronto French Language Services (FLS), July 23, 1997

Metropolitan Toronto is a designated area with respect to the delivery of health services in French. In Metro, there are four designated provincial agencies that must provide French language service:

Clarke Institute of Psychiatry,
Addiction Research Foundation,
Princess Margaret Hospital, and
Toronto Bayview Regional Cancer Centre.

As well, several facilities in Metro Toronto have agreed to implement French Language services:

Bloorview MacMillan Centre;
Mount Sinai;
North York General Hospital;
Sunnybrook Health Science Centre's Independent Living Centre; and
Hospital for Sick Children.

The Health Services Restructuring Commission (HSRC) recommends that the acute care hospitals continue to work with the Metropolitan Toronto District Health Council (MTDHC) French Language Services Committee toward enhancing the provision of French language services. In addition, the HSRC recommends that:

the Child Health Network work with the MTDHC to develop a plan to provide FLS for children;
the facilities that have agreed to implement FLS, or are seeking designation, include representation from the Francophone community on their boards; and
the Metro Toronto Addiction and Mental Health Services Corporation seek partial designation as a FLS provider for the services and programs currently provided by the Clarke Institute of Psychiatry and the Addiction Research Foundation.

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*- Southwest Hospitals -*
Queensway General Hospital	Convert to ambulatory care centre	Transfer clinical programs to The Mississauga Hospital, St. Joseph's Health Centre and the Etobicoke General Hospital Provide ambulatory care programs at the Queensway site	Amalgamate with The Mississauga Hospital into one corporation.
The Mississauga Hospital	Retain	Integrate with clinical programs at Queensway General Hospital	Amalgamate with Queensway General Hospital into one corporation.
St. Joseph's Health Centre	Retain	Receive clinical programs from Queensway General Hospital and the Northwestern site of the Humber River Regional Hospital Assume Level II paediatrics program regional referral role Provide child/ adolescent mental health beds Provide MRI services	No change.
*- Northwest Hospitals -*
Etobicoke General Hospital	Retain	Receive some clinical programs from the Queensway General	No change.
Humber/ River Regional Hospital: Humber site	Retain	Integrate clinical programs from Northwestern site Receive dialysis caseload from Wellesley Central Hospital Provide MRI services	No change.
Humber River Regional Hospital: York-Finch site	Retain	Receive some clinical programs from North York Branson Hospital Assume Level II paediatrics program regional referral role Provide child/ adolescent mental health beds	No change.
Humber River Regional Hospital: Northwestern site	Close	Transfer programs to the Humber and York Finch sites, and some to St. Joseph's Health Centre	No change.

*- North Hospitals -*
North York Branson (NYB) Hospital	Close as an inpatient acute care hospital Convert to Ambulatory Care	Transfer operation and management to North York General (NYG) Hospital Clinical program inpatient volumes to be redistributed to North York General Hospital, Humber/River Regional Hospital: York Finch site, and York Central Hospital	Cease to operate as a public hospital. In a subsidiary capacity with North York General Hospital manage the ambulatory care centre at the Branson site.
North York General Hospital	Retain	Integrate clinical programs from North York Branson Hospital Assume Level II paediatrics program regional referral role Provide child/ adolescent mental health beds Provide MRI services Develop and implement a plan whereby North York General Hospital contracts with the North York Branson Hospital or its owners to manage the North York Branson site	No change.
Salvation Army Scarborough Grace Hospital	Retain	Joint East Metro Task Force with Scarborough General, Centenary Health Centre and Toronto East General and Orthopaedic hospitals, to make binding decisions on the realignment of clinical programs and services	No change.
*- East Hospitals -*
Centenary Health Centre	Retain	Assume Level II paediatrics program regional referral role Provide child/ adolescent mental health beds Joint East Metro Task Force with Scarborough General, Salvation Army Scarborough Grace and Toronto East General and Orthopaedic hospitals, to make binding decisions on the realignment of clinical programs and services	No change
Scarborough General Hospital	Retain	Transfer burn unit to the Sunnybrook Health Science Centre site Receive some Wellesley Central Hospital dialysis program activity Joint East Metro Task Force with Toronto East General and Orthopaedic, Centenary Health Centre and Salvation Army Scarborough Grace hospitals, to make binding decisions on the realignment of clinical programs and services Provide MRI services	No change.
Toronto East General and Orthopaedic Hospital	Retain	Assume Level II paediatrics program regional referral role Provide child/ adolescent mental health beds Joint East Metro Task Force with Scarborough General, Centenary Health Centre and Salvation Army Scarborough Grace hospitals, to make binding decisions on the realignment of clinical programs and services Provide MRI services Receive some clinical programs from the Wellesley Central Hospital	No change.

*- Addictions Services and Mental Health -*
Addiction Research Foundation	Retain	Consolidate programs with Queen Street Mental Health Centre, The Clarke Institute of Psychiatry and The Donwood Institute	Create new corporation with Queen Street Mental Health Centre, The Clarke Institute of Psychiatry and The Donwood Institute.
Bellwood Health Services Inc.	Retain	No further action pending outcome of discussions between the Ministry of Health and the Bellwood Health Services Inc. concerning scope of services and terms of licence	No change.
The Donwood Institute	Retain	Consolidate programs with Queen Street Mental Health Centre, The Clarke Institute of Psychiatry and The Addiction Research Foundation	Create new corporation with Queen Street Mental Health Centre, The Clarke Institute of Psychiatry and The Addiction Research Foundation.
Queen Street Mental Health Centre	Retain	With the concurrence of the Minister of Health consolidate programs with The Clarke Institute of Psychiatry, The Addiction Research Foundation and The Donwood Institute	With the concurrence of the Minister of Health create a new corporation with the Addiction Research Foundation, The Clarke Institute of Psychiatry and The Donwood Institute.
Clarke Institute of Psychiatry	Retain	Consolidate programs with Queen Street Mental Health Centre, The Addiction Research Foundation and The Donwood Institute	Create new corporation with Queen Street Mental Health Centre, the Addiction Research Foundation and The Donwood Institute.

Fact Sheet Metropolitan Toronto Reinvestment and Savings, July 23, 1997

Recommended reinvestment in services

Reinvestment Summary

Recommended reinvestment in capital

Acute Care Hospitals

Capital Reinvestment for Rehabilitation and Complex Continuing Care*

Estimated savings

Summary Table of Total Acute Care Expenses and Savings

Mental Health Savings Estimates

Rehabilitation Savings Estimates

Summary of Total Rehabilitation Costs and Savings

Complex Continuing Care Savings Estimates

Summary of Total Complex Continuing Care Costs and Savings

Fact SheetMetropolitan Toronto Summary of Restructuring Directions by Hospital, July 23, 1997

Summary of Restructuring Notices Concerning Rehabilitation and Complex Continuing Care by Hospital

Fact SheetMetropolitan Toronto Community and Teaching Hospitals, July 23, 1997

University Avenue

Orthopaedic and Arthritic Hospital, Women's College Hospital and Sunnybrook Health Science Centre

Wellesley Central Hospital and St. Michael's Hospital

Doctors Hospital and The Toronto Hospital

Queensway General Hospital and The Mississauga Hospital

North York Branson Hospital

Other community hospitals

Fact SheetMetropolitan Toronto Maternal Newborn and Child Health Services, July 23, 1997

Level II Centres

Level III Centres

Metropolitan Toronto Child Health Network

Fact SheetMetropolitan Toronto Rehabilitation Services, July 23, 1997

Redistributing services

Management and governance

Metro-wide rehabilitation network

Short-Term Rehabilitation Beds Summary

Current and Projected Rehabilitation Beds

Fact SheetMetropolitan Toronto Mental Health and Addiction Services, July 23, 1997

Management and governance

Planning guidelines

Regional agency to monitor transition

Child and adolescent mental health services

Forensic services

Inpatient Beds for Mental Health and Addiction Services for Metro Toronto*

Fact SheetMetropolitan Toronto Long Term Care, July 23, 1997

Management and governance

Complex continuing care

Other Long Term Care "Places"

Impact of the Proposed Planning Guidelines on the Distribution of Long Term Care Services in Metro Toronto

Current and Proposed Complex Continuing Care Beds in Metro

Fact SheetMetropolitan Toronto Human Resources, July 23, 1997

Medical human resources plan

Fact SheetMetropolitan Toronto French Language Services (FLS), July 23, 1997

Fact Sheet
Metropolitan Toronto Reinvestment and Savings, July 23, 1997

Fact Sheet
Metropolitan Toronto Summary of Restructuring Directions by Hospital, July 23, 1997

Fact Sheet
Metropolitan Toronto Community and Teaching Hospitals, July 23, 1997

Fact Sheet
Metropolitan Toronto Maternal Newborn and Child Health Services, July 23, 1997

Fact Sheet
Metropolitan Toronto Rehabilitation Services, July 23, 1997

Fact Sheet
Metropolitan Toronto Mental Health and Addiction Services, July 23, 1997

Fact Sheet
Metropolitan Toronto Long Term Care, July 23, 1997

Fact Sheet
Metropolitan Toronto Human Resources, July 23, 1997

Fact Sheet
Metropolitan Toronto French Language Services (FLS), July 23, 1997