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JULY 23, 1997, Toronto, Ontario -- The Health Services Restructuring Commission (HSRC), an independent body of health experts and professionals, today released its
final directions regarding the restructuring of health services in Metropolitan Toronto.

"Our goal is to achieve the best possible publicly-funded health system for the people of Ontario," said HSRC Chair, Dr. Duncan Sinclair. Dr. Sinclair is the recently retired Vice Principal of Health Sciences and Dean of Medicine at Queen's University.

Based on new provincial planning guidelines developed by the Commission for long term care, home care, rehabilitation services, mental health and sub-acute care, the HSRC unveiled a comprehensive redesign of health services for Metropolitan Toronto.

"This broad vision represents the most comprehensive redesign of health services ever contemplated in Ontario, and will set the stage for building an improved and better coordinated health services system for residents of Metro," said Dr. Sinclair.

In addition to final directions for acute care and hospital based mental health services, the Commission issued preliminary recommendations (Notices of Intention to Issue Directions "Notices") for long term care and rehabilitation services. The deadline for representations for long term care and rehabilitation services is Monday September 15, 1997.

Report highlights

Highlights of the Metropolitan Toronto report on health services restructuring include:

• A comprehensive health system consisting of 24 hospitals on 35 sites.
  
• A total of 7,579 acute, mental health, rehabilitation and complex continuing care beds to 2003, with sufficient capacity to meet the needs of the growing and aging population and for other areas such as sub-acute care;
  
• 6 teaching and specialty hospitals in three academic health science centres promoting excellence in health services, education and research;
  
• 9 community hospital sites offering a comprehensive range of inpatient and outpatient services, including emergency, inpatient mental health, moderate risk maternal newborn services and short term rehabilitation services;
  
• 3 ambulatory care centres to provide outpatient programs, day surgery, diagnostic and other specialized services to local communities;
  
• 7 complex continuing care/rehabilitation facilities on 11 sites;
  
• 2 mental health and addiction services organizations on 5 sites;
  
• Regional Child Health Network to coordinate paediatric and neonatal services;
  
• Regional Mental Health Agency to implement and monitor mental health restructuring within a protected envelop of funding;
  
• $158 to $164 million reinvestment in services such as long term care, home care and sub-acute care;
  
• $187 million in capital reinvestment;
  
• additional 5,207 long term care beds (requiring $97 million in additional annual funding) plus 4,181 places for supportive housing and home care; and
  
• approximately $470 million in annual savings.

Dr. Sinclair stated that there will be no reduction in patient services as a result of
restructuring. "Services will be enhanced for women, for people with HIV/AIDS, for
children and adolescents, for the elderly, for the seriously mentally ill, for residents of the inner city and the homeless, and for people whose first language is not English.
Indeed, the quality and accessibility of services will improve for all residents of the
region."

The Commission continues to support for the creation of the Women's Health Council of Ontario with an $8-10 million annual budget to promote research, education and leadership on women's health across the province. "Women's health issues go beyond geographical boundaries. The Women's Health Council would ensure women across Ontario reap the benefits of advances in health promotion, education, treatment and research," said Dr. Sinclair.

The Commission recognizes that restructuring hospital services must be balanced by reinvestment in other parts of the health system. "That's why we recommend reinvesting $97 million into long term care in Metro Toronto. The additional 9,400 places in nursing homes and homes for the aged, and in the community through supportive housing and home care will help meet the needs of our aging population," he said.

The Commission believes that the realignment of health services in the downtown core will result in a broader, more comprehensive range of services for residents. "Services for the homeless and other inner city residents will be strengthened by bringing together similar programs to improve quality, share expertise and increase efficiency," said Dr. Sinclair.

"Accessibility to HIV/AIDS programs will not be compromised. In addition to the transfer of HIV/AIDS programs to St. Michael's Hospital, services will still be offered at the Bayview Hospital Corporation and The Toronto Hospital, the largest provider of HIV/AIDS services in Metro."

A comprehensive health system for Metro

The Commission recommends a series of measures that will maintain or enhance quality and accessibility to services for people living in Metropolitan Toronto. This will be
accomplished by consolidating services onto fewer sites and putting more resources into providing direct patient care. The recommendations also takes advantage of newer, better quality buildings so that services are provided in the best physical structures.

There are now 39 hospitals on 46 sites in Metropolitan Toronto. After restructuring, the local health system will consist of 24 hospitals on 35 sites (compared to 27 hospitals on 36 sites in the March report).

Community and teaching hospitals

The Commission confirms the merits of the intended directions issued last March report regarding teaching and community hospitals, including:

• integrating the programs and services of the Doctors Hospital at the Western site of The Toronto Hospital, with the Doctors Hospital site closing;
  
• creating a new hospital corporation by amalgamating the Orthopaedic and Arthritic Hospital, Sunnybrook Health Science Centre, and Women's College Hospital, with the Women's College and Orthopaedic and Arthritic sites closing;
  
• creating a new hospital corporation by amalgamating The Mississauga Hospital and Queensway Hospital, retaining the Queensway site as an ambulatory care centre;
  
• transferring most of the inpatient programs of the Wellesley Central Hospital to St. Michael's Hospital, with the Wellesley site closing and the Central site becoming an ambulatory care centre; and
  
• creating the Joint University Avenue Hospitals Task Force to decide on further consolidation of programs and services among Mount Sinai Hospital, The Toronto Hospital and Princess Margaret Hospital.

The Commission also reassessed its decision to designate five Level II sites for neonatal and paediatric services. The HSRC 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.

In response to representations from the community, the Commission amended its
directions to ensure community representativeness on hospital boards and safeguard designation of priority programs in new amalgamated hospitals and in hospitals assuming new roles and responsibilities.

Mental health services

The Commission also confirms its decision to amalgamate the Clarke Institute of Psychiatry, Addiction Research Foundation, Donwood Institute and, with the concurrence of the Ministry of Health, Queen Street Mental Health Centre. 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 of Health about the scope of its services.

New planning guidelines developed by the Commission will allow for a more gradual shift from hospital-based to community-based mental health services. A total of 973 mental health and addiction services beds to the year 2003 (compared to 922 in the March report).

The Commission strongly believes that community-based services and supports must be in place before hospital beds are reduced. The HSRC continues to support the creation of a temporary regional mental health agency to oversee the restructuring of mental health services. The regional mental health agency will have the authority to implement and monitor the restructured mental health system within a "protected" envelope of funding. It will be responsible for identifying the mental health needs of the community and determining the best mix of services to meet those needs.

Rehabilitation services

Our review of rehabilitation services shows that there are sufficient beds in the GTA. However, a distribution problem exists. The rehabilitation beds in Metro Toronto will decrease but, there will be a proportional increase in the balance of the GTA. The same number of people will be treated by shifting from providing services on a five-days-a-week basis to seven-days-a-week.

The Commission issued preliminary recommendations (Notices) regarding rehabilitation services in Metropolitan Toronto. There will be a total of 721 rehabilitation beds, a decrease of 29 per cent compared to the current number of 1,013.

Short term rehabilitation services will be redistributed among Metro's acute care hospitals. The restructuring of long term and regional programs will result in the following:

• 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 Centre for Geriatric Care 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 (Tri-hospital Rehab Corporation) will be formed by the amalgamation of RIT, Lyndhurst Hospital and Toronto Rehabilitation Centre.

Long term care

In Metro, the HSRC identified the need for 9,400 more long term care places, an increase of 34 per cent. Of that number, over 5,200 represent more beds in nursing homes and homes for the aged, requiring about $97 million in additional annual funding. The rest of those places should be in supportive housing, long term care and attendant care.

Based on new planning guidelines, Metro Toronto has too many complex continuing care (formerly known as chronic care) beds. The HSRC recommends that Runnymede, Riverdale, Dewson and Toronto Salvation Army Grace hospitals close. These hospitals may consider applying to the Ministry of Health to provide long term care services in new facilities. Our Lady of Mercy Pavilion of St. Joseph's Health Centre, and Scarborough General Hospital, will also cease to provide complex continuing care services.

Sub-acute care

The proposed planning guideline for sub-acute care beds will result in 493 beds by 2003. The Commission will consult the Metropolitan Toronto District Health Council on the best option for locating sub-acute care beds. Advice and representations from health professionals and the community are also welcome.

Size

There will be a total of 7,579 beds, plus an additional 682 beds to meet future growth.

• 4,443 acute care beds
  
• 493 sub-acute care beds (new)
  
• 973 addiction treatment and mental health beds
  
• 43 forensic beds
  
• 721 rehabilitation beds
  
• 1,399 complex continuing care beds

The Commission recognizes that restructuring cannot occur without significant reinvestment in community services and supports, and capital renewal projects. In Metropolitan Toronto, the HSRC recommends the following reinvestment in services:

• $28 million in acute home care, an increase from $7.3 million in March;
  
• $97 million in long term care, an increase from $25 million in March;
  
• $26 to $32 million in sub-acute care, an increase from $22 million in March;
  
• $5 million for five Magnetic Resonance Imaging units is also recommended.

Restructuring of the Metro Toronto health system will result in $470 million in annual savings, or 17.5 per cent of net expenses (compared to $430 million in the March report).

Implementation

The Commission expects implementation of its directions and recommendations for Metropolitan Toronto to be completed by December 1999. To facilitate implementation of restructuring, the HSRC is establishing regional implementation teams based on the geographic clustering of hospitals in the north/northwest, southwest and southeast Metro.

Dr. Sinclair said the Commission believes its recommendations will lead to positive change. "The measures outlined today will lead to improved quality and better access to a wide range of services for the residents of Metropolitan Toronto. Our recommendations to reinvest in community-based services, and to upgrade and expand facilities will ensure that the health system will be able to meet the needs of the community well into the 21^st century."

The Health Services Restructuring Commission is a group of individuals appointed by the Government of Ontario to redesign the Ontario health system. It is an independent agency of doctors, academic health science professionals, hospital administrators, former hospital board members and other experts. The Commissioners work with local district health councils, hospital boards and other health professionals to restructure health services for each community. The Commission has a four-year mandate to restructure hospital systems and advise the Minister of Health on reinvesting in and restructuring other services to meet the health needs of the people of Ontario.