October 03, 2001

Contact:
Nancy Lawrence
Media Relations, LHSC
519-685-8500, ext. 77642

London Health Sciences Centre defines future direction

(LONDON, Ontario) - The Board of Directors of the London Health Sciences Centre (LHSC) today announced a new strategic direction and their approval of recommendations resulting from the latest phase of LHSC’s four-year renewal plan. The strategic direction defines a clear vision for LHSC and a detailed plan to provide future healthcare to the communities it serves. It also helps us maintain and strengthen our international reputation as a leading, innovative research and academic health centre.

The decisions approved by the board will allow LHSC to best align its financial and human resources, and other key operational and capital planning projects, to provide the highest quality of care to patients in London, Middlesex and beyond in selected specialty programs and services.

"As a foundation for our renewal work, LHSC established a clear vision - to focus our efforts on providing the London/Middlesex communities with excellence in patient care, education, research and innovation" says Board Chair Geoff Davies. "In addition LHSC will pursue a leadership role in the development of a regional network of health and academic services to make the right choices for patient care across the region."

LHSC initiated its renewal plan in May 2000 to determine how best to preserve the high standards of patient care and internationally recognized academic leadership for which it is known. An Operational Review conducted by the Ministry of Health and Long-Term Care (MOHLTC) at the request of LHSC found that LHSC had achieved a high level of efficiency, however, the report also indicated that LHSC needed to redefine the scope and size of its clinical and academic programs if it was to sustain itself within the challenging realities of today’s healthcare system.

"We have accepted the reality that we can not be all things to all people. The recommendations which the board approved have been made to sustain and develop our reputation as a centre of excellence," explains Tony Dagnone, President and CEO of LHSC.

"Advances in medical science and technology hold promises of unprecedented benefits to patients. We recognized that we needed a plan to guide our future direction and to ensure the future wellbeing of our patients. We needed a plan that would enable us to keep pace with advances in knowledge and technology and, at same time, successfully respond to the increasing challenges facing all hospitals - challenges such as a national shortage of medical specialists, increasing costs, an aging population and the need to balance budgets," says Mr. Dagnone.

In March 2001, Phase One was completed with the development of planning principles and criteria. LHSC’s first, and foremost, priority is to provide primary, secondary, and some specialized services to the people of London/Middlesex. The hospital will also continue to operate as a regional referral centre for selected, highly specialized clinical services and lead in the development of a regional health network.

On Oct. 2, the LHSC Board of Directors approved the scoping recommendations put forth by the Steering Committee. The Committee wrote its recommendations following an intensive and consultative process involving more than 250 people, including physicians, staff, third-party consultants, government, and community partners from London Regional Cancer Centre, The University of Western Ontario, and St. Joseph’s Health Care London.

"The decisions that have been made ensure that LHSC will continue to meet the fundamental health care needs of London and Middlesex County, and support our essential academic capabilities. More than that, these decisions also allow LHSC to continue to provide highly specialized care in a number of areas for which it has earned national and international reputations," says Mr. Davies. "LHSC will coordinate access to care with other providers for those patient care services that are being scoped out of our program delivery."

For the vast majority of LHSC’s patients, doctors, staff and students, these decisions will have little or no impact. These people will receive and deliver the high standard of care they do today from a stronger, more-focused LHSC.

"While the numbers may be small, we recognize that there will be some disappointment and a sense of loss for those patients and their families within the programs which we are redirecting. Without question, staff and physicians directly impacted will also feel a sense of loss. These decisions are about far more than numbers - they are about the people we care for and care about," says Mr. Dagnone.

Our first priority has been to preserve access and excellence in those programs that so many of our patients in London-Middlesex and surrounding areas rely on and where our scoping evaluations clearly indicate we can remain strong. As a result, vital specialized programs such as emergency/trauma, adult cardiac bypass surgery, orthopedics, renal care, high-risk obstetrics, pediatric critical care, kidney and liver transplants, and cancer care will continue to be part of LHSC’s extensive future focus. (See background document "Scoping Summary" for a complete list of future services)

The recommendations approved by the Board will also mean redirecting a small number of specialties where, analysis showed, LHSC would not be able to sustain its leadership in the future. LHSC will continue to provide pre and post treatment care to many of these patients, however, they will be referred for treatment to other hospitals that are focused in these areas and, therefore, better able to support the high quality of care LHSC believes their patients should expect.

"We want you to understand that these decisions have not been taken lightly, nor without consideration of the impact they will have," says Mr. Dagnone. "But they are the right decisions for the future health of all of our patients, both those we will continue to serve directly, and those whose specialized care will be provided by our health partners."

The Board of Directors approved the removal of a total of 18 services from the list of services currently provided by LHSC including some that can be provided through clinics and physicians. These services are:

(See attached background document for definitions of each of the services listed above.)

"Over the next few months we will be working with our clinical leaders to implement these decisions. During the transition process the needs of our patients and staff who are affected by these decisions will be our foremost consideration. No changes will occur until we are satisfied that the appropriate transition plans are in place for our patients," Mr. Dagnone adds. "I have every reason to believe that our new strategic direction will enhance our ability to work with our Ministry of Health to address our waiting lists for those programs that will remain integral to our academic centre."

"In the case of pediatric cardiac surgery, which is being scoped out of our range of services, we used benchmarks established as a result of the Justice Sinclair Report and others in the field which clearly indicates that a minimum patient volume of 150 cases per surgeon is required to sustain a program," says Dr. Murray Girotti, Vice President, Medical Staff. "LHSC/CHWO currently performs approximately 120 cases. As well, it was determined that if we were to not only sustain, but develop this program, we would need to make significant investments in technology upgrades and staff recruitment and development."

"The challenges that we face are shared by healthcare providers across the country, and they need to be addressed today if we are to secure strong and vibrant healthcare services for our patients tomorrow. Our staff, management, government partners and Board have devoted considerable time and energy in arriving at these decisions. We are confident that, with this plan for the future, we will be in the best position to not only sustain our organization, but to make the most of the opportunities that lie ahead," adds Mr. Davies.

Note: a community telephone line has been set up for the public to call with questions and comments. The number is 519-685-8500 ext. 50150.

Media Backgrounder
Chronology:

• In 1998, the London Health Sciences Centre Board of Directors determined it could not balance its budget without limiting access to care, which the Board was reluctant to do. Instead, the Board chose to approve a budget with a projected deficit in order to ensure that the people of Southwestern Ontario continued to have easy access to the best possible health care, but at the same time, pursued a more active dialogue with the Ministry of Health to find a solution to the financial impasse.
  
  
• In March 1999, the Board of Directors invited the Ministry of Health and Long-Term Care to initiate an Operational Review of LHSC as a means to identify, through an independent and objective analysis, the reasons for the deficit, and to determine how LHSC could recover the deficit and operate within a balanced budget. The review consisted of an intensive and comprehensive five-month review of the hospital’s clinical, operational and financial performance.
  
  
• The Operations Review of March 2000 conducted by MOHLTC at the invitation of LHSC, directed LHSC in three specific areas:
  
  
  1. To review the scope and size of the services provided by LHSC to determine the optimal mix of quality services needed by the residents of London and Middlesex (scoping);
  2. To assess which primary and secondary case types could be provided closer to home to residents residing outside of the London area (sizing);
  3. To determine how best to provide high quality patient services to achieve operational and clinical financial targets and re-establish financial stability.
     
     
• In May 2000, LHSC’s Board announced the start of a four-year Renewal Plan, which included the scoping initiative.
  
  
• A Steering Committee was struck in fall 2000 to lead the scoping project. Throughout the past year, the committee has involved more than 250 people in this consultative process to reach the recommendations, which were brought to the Board of Directors on Oct. 2, 2001 for approval. The Scoping Process was not simply a financial review of operations. The health centre’s ability to provide the care based on human resources as well as current and future technology/equipment needs were all factored into the deliberations.

Service Definitions:

Dermatology Clinics: outpatient care treating conditions of the skin.

Ultraviolet Therapy: outpatient clinic treating conditions such as psoriasis using sunbeds.

Travel Clinics: outpatient services providing information and immunization for overseas travellers.

Sleep Apnea index of less than 20: will only operate on more severely compromised patients with a sleep lab assessment index of greater than 20. Sleep apnea is a disorder where patients suffer episodes of cessation of breathing during sleep.

Lung reduction procedures: experimental surgical procedure to treat emphysema by surgically reducing size of lung to increase lung volume.

Lung transplant procedures: removal of damaged lung tissue followed by transplant of healthy lung tissue from either a living or deceased donor.

Bowel transplant procedures: removal of damaged bowel with healthy bowel from deceased donor transplanted into patient.

Burns (> 20% adult, > 15% pediatric): extensive burns or non-extensive burns which require patient ventilation (life support). Minor burns will continue to be treated by plastic surgery.

Pediatric rheumatology: outpatient clinic to manage conditions such as arthritis and lupus in children.

Obesity procedures: high gastric surgical procedure for patients defined as morbidly obese

Cosmetic Surgery non-insured by OHIP: cosmetic surgery such as breast augmentation, liposuction or face lifts.

Complex ankle surgery: highly specialized and complex surgical repair of foot and/or ankle.

Cardiac transplant surgery (adult and pediatric): removal of damaged heart followed by transplant of healthy heart from a deceased (cadaveric) donor.

Cardiac arrhythmia surgery: surgical treatment of irregular heart rhythm (majority of cases now treated medically).

Pediatric cardiac surgery: highly specialized procedures to repair defects in the heart such as a hole or poor pumping function.

Complex pediatric craniofacial surgery: complex reconstruction of facial and skull deformities.

Endovascular aneurysm surgery: surgical intervention to treat patients with aortic aneurysm by insertion of a stent to repair damage. Currently not considered standard of practice and therefore not funded by Ministry of Health.

Therapeutic radionucleotides: experimental pharmaceutical treatment of pain management in cancer patients using nuclear medicine approaches. Alternate pain management techniques will be used.

Scoping Summary:

The Final Recommendations by Service Grouping

Medicine

• Will primarily serve London and Middlesex.
• Will serve the region for a few programs, such as complex heptobiliary care aligned with liver transplant, inflammatory bowel disease, cystic fibrosis and chronic obstructive pulmonary disease
• Will offer some services- asthma, geriatric and diabetes -- in collaboration with St. Joseph's Health Care London (SJHC).
• Will no longer offer dermatology clinics, ultraviolet therapy and travel clinic
• Will evaluate a proposed Regional Haemophilia Program
• Will develop more "urgent access points" to speed referrals from family doctors and reduce non-emergency ER visits

Surgical

• Will focus primarily on London and Middlesex, with some services, including breast surgery, urology oncology, thoracic and aneurysm, serving the region.
• Will refer cosmetic and obesity surgery, major burns (> 20%), lung volume reduction, and endovascular aneurysm to other centres.
• Will more clearly define roles of LHSC and SJHC in shared programs

Obstetrics and gynaecology

• Will serve the region for high-risk obstetrics, prenatal diagnosis, general and oncological gynaecology and uro-gynaecology
• Will provide Reproductive Endocrinology and Infertility services, including Artificial Reproductive Technology, on a provincial and national basis.

Pediatrics

• Will serve London and Middlesex with most pediatric services
• Will refer pediatric rheumatology, major cranio-facial surgery, cardiac surgery, cardiac transplantation and major burns to other centres.
• Will offer some services, such as gastroenterology, neurosurgery and respirology, through shared adult programs.
• Will provide neonatology on a regional basis.
• Specialized pediatric services will continue to be provided in such areas as oncology, nephrology, neurology and critical care

Cardiac

• Will provide most cardiac services regionally.
• Will refer cardiac arrhythmia surgical treatments, pediatric cardiac surgery and heart and lung transplantation to other centres.

Transplant

• Will focus on further developing adult and young adult kidney transplantation and adult and pediatric liver transplantation.
• Will refer patients requiring heart, lung or bowel transplants to other centres.
• Will continue to coordinate pre- and post-operative care for London and Middlesex County patients undergoing heart, lung and bowel transplants in other centres.

Oncology

• Will continue to offer oncology services to southwestern Ontario, in partnership with London Regional Cancer Clinic.
• Will refer patients requiring radionucleotide therapy (a rare experimental therapy to treat pain in bone cancer) to other centres.
• Will explore new care delivery models to treat patients closer to home

Emergency/Trauma

• Will continue to offer all aspects of emergency care to London and Middlesex.
• Adult Urgent and Less Urgent/ Non-urgent Care will be provided in partnership with SJHC.
• Will continue to serve the region for adult and pediatric trauma
• Will explore new models of care to reduce burden on ERs

Clinical Neurosciences

• Will continue to be a regional program
• Will provide treatment for intractable epilepsy on a provincial and national basis
• Will further explore sizing, siting and enablement issues

Orthopaedics

• Will continue to offer regional service for joint replacement and advanced spine services.
• Will continue to offer sports medicine on a provincial and national basis.
• Will refer patients requiring complex ankle joint replacements to other centres.

Head and Neck

• Will continue to offer service on a regional basis
• Will discontinue surgical intervention for sleep apnea assessment for < 20.
• Will continue to explore sizing and repatriation issues

Nephrology

• Will continue to offer services on a regional basis, using satellite units and home care

Family Medicine

• Will continue to offer services primarily to the people of London and Middlesex
• Palliative care will be offered in partnership with SJHC.

Psychiatry

• Will continue to draw 90 per cent of its patients from London and Middlesex.
• Will offer services to the region for first episode psychosis, child and adolescent mental health and eating disorders, although sizing of these services will be reviewed
• SJHC will take lead in regional chronic mental health services