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Health Services Restructuring in Ontario

OHPE Bulletin #13.1 July 25, 1997

1. The Metro Toronto Health Services Restructuring
2. Related Resources
3. Addictions & Mental Health Services Restructuring
4. Evaluating Rural & North Health Programs

This week there is an interesting combination of items in the three messages, many related to the impact of health service changes. As usual we have announcements of conferences, appointments, funding programs etc. in this first message. We begin with a notice of a change in the Ontario Ministry of Health, and end our announcements with a note about funding application. This is a special feature on announcements from the Health Services Restructuring Commission about hospital closings, mental health service reform and rural health system changes, as well as related resources.
- Alison Stirling

1. HSRC Commission Redesigns Health Services In Metro Toronto

[edited from the Press Release of the HSRC]

TORONTO, July 23 /CNW/ - 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.

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.

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

- 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;

- 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 amended its direction to close North York Branson Hospital. Upon further review of the health needs of the population, the HSRC recommends that North York Branson Hospital convert to an ambulatory care centre. Operation and management of North York Branson Hospital will be transferred to North York General Hospital.

A total of 7,579 acute, mental health, rehabilitation and complex continuing care beds.

As well:
- Regional Child Health Network to coordinate paediatric and neonatal services;
- Regional Mental Health Agency to implement and monitor mental health restructuring within a protected envelope 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 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 21st century.''

version française disponible

For further information: (English) Ruth Lewkowicz, (416) 327-5504; (French) Francine Robitaille, (416) 327-9122

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2. Related Resources:

2. a. "Metropolitan Toronto Health Services Restructuring Report" Health Services Restructuring Commission, 56 Wellesley Street West, 12th Floor, Toronto M5S 2S3 July 1997

"This is the second report issued for Metropolitan Toronto by the Health Services Restructuring Commission (HSRC). It includes the HSRC's directions for hospital restructuring in Metro following the notices of intention issued on March 6, 1997.The HSRC used as its starting point the Metropolitan Toronto District Health Council's hospital restructuring project completed in November 1995. The MTDHC strongly supported a significant planned reconfiguration of hospital services in Metro Toronto. In spite of positive steps that have been taken by hospitals, the HSRC recognizes that Metro Toronto's hospital sector is characterized by duplication of services, surplus capacity, an over-concentration of services in the downtown core and aging physical plants.

. This report presents the highlights of [these] intentions [for acute care, mental health and addiction services], a summary of the principal issues raised in the representations, the HSRCs deliberations, and its final directions and advice."

Additional reports released July 1997 include: "Notices of Intention to Issue Directions and Advice - Rehabilitation & Chronic Care Services"; and "Directions and Advice". All three reports may be ordered from the Health Services Restructuring Commission at the above address or:

Tel: (416) 327-5919 or 1-800-565-4453
Fax: (416) 327-5689 or 327-1137

** A now for a different perspective **

2. b. "Who's Counting? The Faulty Calculations of the Metropolitan Toronto District Health Council's Hospital Restructuring Committee" by Georgina Feldberg, Director, & Fiona Miller, Grad Associate, Centre for Health Studies, York University, North York, ON M3J 1P3 November 1996

Academic researchers at the York U. Centre for Health Studies (YCHS) undertook an extensive review of the Metropolitan District Health Council Hospital Restructuring Committee's (HRC) Final Report and the appendices, technical, background and working papers that informed it.
Their review determines that:
- the HRCs work is deeply flawed both methodologically and analytically and
- errors in data collection and analysis undermine the accuracy of estimations of population need and costs savings

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3. Addiction & Mental Health Services

The Health Services Restructuring Commission confirmed 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.

Since April, the four organizations have worked as partners, actively working toward the creation of a single addictions and mental health organization must be established by November 30, 1997. The partners have defined the framework of the corporation and its core values following consultations with clients, the community and staff.

The four organizations also see the merger as an opportunity to enhance the quality and level of service to people who suffer from both a mental illness and an addiction problem.

New planning guidelines developed by the Commission are to enable a 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 supports 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.

[from a HSRC press release July 23 1997)

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4. Evaluating Northern and Rural Health Programs and A Rural and Northern Health Care Framework

[from Ministry of Health press release]

TORONTO, July 16 /CNW/ - The Ontario government is providing $1.85 million over five years for an independent evaluation of various northern and rural health care initiatives.

The Northern and Rural Research Unit will evaluate health professional and training initiatives, and various northern and rural health programs and services.

The research unit consists of faculty from Laurentian University and Lakehead University, as well as representatives from the Northwestern Ontario Family Medicine Program, and the Sudbury and District Public Health Unit.

This news release is available on the Ministry of Health Website at:

For further information: Lily Weedon, (416) 327-8503, Communications and Information Branch

At a related event on June 27th, Minister of Health Jim Wilson announced a new Rural and Northern Health Care Framework: to improve access to, and the delivery of, health care services for people in rural and Northern Ontario communities.

"Hospitals within about 40 kilometers of each other will be expected to form clusters with shared administrative, support and clinical functions. They will also be encouraged to explore opportunities for common governance.

If a hospital cluster is more than about 40 kilometers away from a full service emergency hospital, at least one of the hospitals within the network will have enough secondary resources to provide level B emergency care, where a physician will be on-site or on call.

Other hospitals will provide level A access, where specially trained nurses will assess, stabilize and in some cases, treat patients, with assistance from physicians over the phone. In some areas, there may be a need to establish more than one hospital cluster within the same network.

Rural hospitals which are the only hospital in their community, will provide 24 hour access to care unless it is determined that a nearby hospital is better equipped to provide those 24 hour services through the network planning process. However, this will be determined by the local communities themselves.

The framework does not exempt rural and northern hospitals from restructuring. Nor does it preserve the status quo or impose specific, Toronto based decisions on specific hospitals! These kinds of decisions will be made by hospitals, district health councils and the commission through the use of the framework.

[from a speech by the Minister at Alexandra Marine and General Hospital 06/27/97)