TORONTO, March 6, 1997 - The Health Services Restructuring Commission today released its report and recommendations on restructuring hospital services in the Metropolitan Toronto area.

The restructuring plan, based on the criteria of high quality, accessibility and affordability, is contained in the notices of intention to issue directions, which the Commission has released to local hospitals, the Metro Toronto District Health Council and the Ministry of Health.

"Our goal is to preserve Ontario's health services and to help shape them into a health services system that can best meet the needs of our eleven million people. This system should provide high quality health services to all Ontarians at a price that we can afford. And it should be a system that not only makes sick people well but helps well people stay well as we enter the 21^st century," said Dr. Duncan Sinclair, chair of the Commission.

The Commission recognises that each community is distinctive. It works from the principle that local solutions tend to be more sensitive to community needs than those imposed from afar. The Commission's goal in each community across the province is to make decisions that augment local efforts to move forward logically and sensibly, taking into account population growth, demographic factors, and provincial standards of effectiveness and efficiency.

The Commission's recommendations build on the excellent work already done by the Metropolitan Toronto District Health Council. The Commission also reviewed hundreds of submissions, met with representatives of many hospitals and other organizations, and conducted its own research and analysis.

The volume and quality of health care services in Toronto are unequalled in the rest of the province. In addition to 39 publicly-funded hospitals on 46 sites, Metro has a wide array of community-based health and health care services and the largest academic health sciences complex in Canada.

The Commission found that the hospital sector in Metro Toronto contains duplicated services, excess capacity, a high concentration of services in the downtown core, and aging physical plants. It must be reorganized to safeguard its continuing capacity to provide high quality and high volume services.

The restructuring plan laid out by the Commission calls for a system that has improved access and linkages, common standards, and the integration of structures, standards and systems to make services more efficient, effective, equitable and economical.

Acute Care Hospitals

The Commission's analysis demonstrated that as a result of the declining use of inpatient beds, there is substantial capacity -- a full one third -- not being used. Moreover, as hospitals maximise efficiencies, improve best-practice benchmarks, and respond to financial constraint, this unused capacity will grow even larger.

In the downtown core, the Commission has made the following recommendations to reduce further unused capacity and increase efficiency:

• The Commission is directing Mount Sinai Hospital, Princess Margaret Hospital and The Toronto Hospital, including the Western Division, to establish a joint committee, the Joint University Avenue Hospitals Task Force, to decide on further consolidation of programs and services.
  
• The Orthopaedic and Arthritic Hospital and Women's College Hospital will amalgamate with Sunnybrook Health Science Centre to form a single hospital corporation on the Sunnybrook site. The Orthopaedic and Arthritic and Women's College Hospital sites downtown will close.
  
• St. Michael's Hospital will assume ownership, operation, management and control of the Wellesley Central Hospital. The Central Hospital site will become an ambulatory care centre with its own board, linked with that of St. Michael's Hospital. Management for the centre will be provided by St. Michael's Hospital. The Wellesley site will close.
  
• Doctors Hospital will close and its services will be designated a priority program, fully integrated into the Western Division of The Toronto Hospital.

• The Queensway General Hospital will amalgamate with The Mississauga Hospital to form a single hospital corporation. The Queensway General site will become an ambulatory care centre.
  
• North York General Hospital will assume operation and management of North York Branson Hospital. North York Branson will close and its programs will be transferred to North York General Hospital, Humber/Northwestern/York-Finch Hospital and York Central Hospital.
  
• Humber/Northwestern/York-Finch Hospital will close the Northwestern site.

All acute care community hospitals will provide low-risk obstetrics, newborn and Level I neonatology services and ambulatory paediatric services. North York General Hospital, Centenary Health Centre, Toronto East General & Orthopaedic Hospital, Humber/Northwestern/York-Finch Hospital (Finch site) and St. Joseph's Health Centre will provide Level II neonatal and inpatient paediatric services.

A Child Health Network led by the Hospital for Sick Children will be established to co-ordinate the reorganization of neonatal and paediatric services.

Mental Health

The Commission is recommending that the Minister of Health establish a Metro Toronto Addictions and Mental Health Agency. The agency will oversee the restructuring of mental health and addictions services, and will manage all mental health and addictions funding in Metro Toronto.

The Queen St. Mental Health Centre, the Clarke Institute of Psychiatry, the Donwood Institute and the Addiction Research Foundation will create a new hospital corporation. The Commission is also advising the Minister to revoke the license of Bellwood Health Services to provide hospital services and transfer patient services to the Donwood Institute.

Long-term Care and Rehabilitation Services

To meet the needs for long-term care and rehabilitation, the Commission is currently undertaking research to establish policy and planning targets to guide its decisions. This research is expected to be completed next month and will be published for comment and feedback.

With respect to rehabilitation, the Commission's conclusions concerning these services will be made shortly, once policy and planning targets are established.

Current planning guidelines identify excess chronic care bed capacity in Metro Toronto. The Commission is therefore directing the closure of the Runnymede Chronic Care Hospital and the Salvation Army Toronto Grace Hospital.

The Commission recognises that both Runnymede Chronic Care Hospital and the Salvation Army Toronto Grace Hospital have a long and valued tradition of providing long-term care services. The Commission is advising the Minister of Health to entertain proposals from these two organizations for the provision of more long-term care services in new facilities.

Our Lady of Mercy Pavilion, which is operated by St. Joseph's Health Centre, will close and its patients will be transferred to Queen Elizabeth Hospital or to other long-term care facilities depending on the needs of each patient The Commission is also advising the Minister of Health to revoke the private hospital license of the Dewson Hospital.

These hospitals will work with the Placement Coordination Service and other long-term care facilities to develop plans to transfer patients to the most appropriate settings for their needs.

The Commission is recommending to the Minister of Health that $25 million in operating funds from these four facilities be reinvested in the expansion and strengthening of long-term care services, including additional investments that may be required to provide home care services to long-term care patients.

Beds

This restructuring plan will eliminate excess capacity of beds in Metro Toronto while ensuring there remains sufficient capacity to meet future growth:

• 4,414 acute care beds from 6,173 (March 31, 1996)
  
• 512 transitional care beds (new)
  
• 511 acute mental health and addiction treatment beds from 603
  
• 345 chronic mental health beds from 506
  
• 43 forensic beds - no change
  
• 1,003 rehabilitation beds - no change (pending review to be completed in March)
  
• 2,133 chronic care beds from 2,376 (pending review to be completed in March)

Total savings from implementation of this restructuring plan are $430 million or 15.7 percent of total acute and chronic care expenses based on 1995/96 operating expenses of $2.7 billion.

The Commission strongly believes that reinvestment in home care and other community services such as long-term care must be in place before reductions in hospital services take place. To that end, the Commission is recommending the following significant reinvestment:

• a minimum of $7.3 million in home care expanding service by 183,000 visits,
  
• $18.8 to $21.7 million in transitional, or sub-acute care,
  
• $25 million in long-term care, including additional investments that may be required to provide home care services to long-term care patients.

The Commission is also recommending to the Minister of Health that $143 million be reinvested in new construction and renovations plus an additional $15.1 million for furnishings and equipment to implement the restructuring process.

Provincial Initiatives

The restructuring process in Metro Toronto and other communities has led to the development of province-wide initiatives:

• A Provincial Paediatric Task Force comprising hospital and university representatives will be asked to prepare plans and recommendations for program consolidation of specialised surgical and transplantation services. Universities and providers from Toronto, Ottawa, London, Hamilton, Kingston, Thunder Bay, Sudbury and Windsor will be involved.
  
• An independently-governed Women's Health Council of Ontario with responsibility for advancing leadership in women's health and improving the health status of women through health education and through identification and promotion of best practices in women's health and health care. We are recommending to the Minister an annual budget of $8-10 million.

The Commission is requiring all affected hospitals to work with their employees' representatives develop human resources plans. A fact finder will be appointed to establish a process whereby hospitals and employees' representatives can develop this plan quickly.

A fact finder will also be appointed to examine issues of physician privileges that will arise as a consequence of restructuring. The fact finder will consult hospitals and physicians' representatives regarding the development of a medical human resources plan.

The Commission is expecting implementation of its directions and recommendations for Metropolitan Toronto to be completed by the end of 1999.

"Although restructuring the hospital system will change where people in Metro Toronto receive their health services, the volume of services will not be reduced," Dr. Sinclair concluded. "We must all work together to preserve our excellent health care services. We believe this restructuring is the best way for all of us to reach our health care goals."

Local individuals and organizations will have 30 days to send in written comments. After considering new information received during this period, the Commission will issue its final directions to hospitals and recommendations to the Ministry of Health.

The Health Services Restructuring Commission is an independent and expert agency established by the Ontario Government with a four-year mandate to review health services across the province. It has been charged with restructuring hospital systems and advising the Ministry of Health on reinvesting in and restructuring other health services to improve quality and patient outcomes.

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