The Scarborough Hospital - Alliance Discussions. Presented to the Central East LHIN Board of Directors February 22, 2012

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1 The Scarborough Hospital - Alliance Discussions Presented to the Central East LHIN Board of Directors February 22, 2012

2 Objective To respond and provide direction to Integration discussions between The Scarborough Hospital and the Toronto East General Hospital (TC LHIN). 2

3 Outline Background to the Clinical Services Plan The Voluntary Integration Process Decision Making Criteria Information on the Toronto East General Hospital (TEGH) and The Scarborough Hospital (TSH) Alliance discussion Expectations of the Central East LHIN Planning and Service Delivery Community Engagement 3

4 Scarborough Hospital Alliance Discussion CLINICAL SERVICES PLAN 4

5 Central East Clinical Services Plan One Acute Care Network Vision Improved and equitable patient access to an integrated hospital system that provides the highest quality of care across the Central East LHIN 5

6 Clusters and Service Delivery Recommendation: Deliver clinical services via geographic clusters, which will vary between the five clinical models Thoracic Vascular Mental Health and Addictions Cardiac Maternal and Paediatric 6

7 Clinical Service Plan in the Scarborough Cluster Clinical Program Hospital Involvement Cardiac RVHS (TSH-RVHS-LHC ) Joint Regional CardiacPrograms (Cath, CODE STEMI, Cardiovascular Rehab) (2010, 2011) Vascular Thoracic (& Cancer) TSH (TSH-RVHS) Initiated Funding additional TSH EVAR cases ( ) Supported TSH Renal Program and Diabetes Service Expansion (2011) LHC (All LHIN) Voluntary Integration of Thoracic Surgery (2010) Voluntary Integration to expand cancer services in Scarborough (TSH- RVHS-LHC, 2009) Outstanding Issues/Challenges No issues/challenges - ExcellentCooperation and Outcomes TSH Human Resource Challenges and EVAR funding have limited progress Physician Acceptance Mental Health and Addictions Maternal and Pediatric TSH RVHS Implementing MHA Common Assessment and Bed Registry LHIN wide. Supported MHA community enhancements. (2011) TSH RVHS Are to establish a centre for Advanced Level 2 in-patient Neonatal and Pediatric care to be sited in the Scarborough cluster. The centre will act as a LHIN wide resource and be accountable for coordinating sub-specialty programs to meet the needs of each cluster. RVHS and TSH should also explore further integration opportunities within their maternal child and youth programs. Coordination of Community MHA TSH agreement to proceed with Implementation. May require LHIN direction or facilitation. 7

8 Supporting Our Scarborough Communities In addition to the Clinical Services Plan, the Central East LHIN has deployed new resources to meet the unique needs of Scarborough: Specialized Geriatrics (TSH & RVHS) GAIN, GEM Nurses, NPSTAT to LTC Behavioural Supports Ontario Assisted Living Services For At Risk Seniors Enhanced Community Support Services, including Adult Day Programs, Transportation, Home at Last, Home First Service Improvements in Hospice and Palliative Care, Chronic Disease and Mental Health and Addictions 8

9 Scarborough Hospital Alliance Discussions INTEGRATION REQUIREMENTS AND DECISION MAKING 9

10 Integration Requirements: General Health Service Providers (HSPs) are required by legislation to pursue integration opportunities HSPs are required to provide formal notice, and obtain LHIN approval before proceeding with an integration The LHIN is not empowered to alter an HSPs corporate structure (e.g., dissolve an entity), as this power is purview of the Minister or the HSPs However, LHINs have the mandate to review and approve ALL health service provider integrations, including those that Transfer, merge or amalgamate services, operations, persons or entities 10

11 Integration Type Integration Activity (LHSIA S.2) LHIN Funding (LHSIA S.19) LHIN Facilitated and Negotiated (LHSIA S.25) LHIN Required (LHSIA S.26) Voluntarily Initiated by HSP (LHSIA S.27) Minister s Order (LHSIA S.28) Coordinate services and interactions between different persons and entities Partner with another person or entity in providing services or in operating X X Transfer, merge or amalgamate services, operations, persons or entities LHIN s do not have power to alter HSP corporate structuresinput provided to Minister excludes amalgamation of health service providers S.26(2)(e) Applicable to one or more of the HSPs involved Start or cease providing services Applicable to one or more of the HSPs involved Cease to operate or to dissolve or wind up the operations of a person or entity X LHIN s do not have power to alter HSP corporate structuresinput provided to Minister X LHIN s do not have power to alter HSP corporate structuresinput provided to Minister X LHIN s do not have power to alter HSP corporate structures- input provided to Minister Applicable to one or more of the HSPs involved Services must be funded at least in part by the LHIN. Per S25(1)(a) Integration by providing or changing funding to a health service provider under S.19(1) Per S.25(1)(b) Integration of persons or entities where at least one is a health service provider or integration of services between heath service providers Per S.26(1) LHIN requires one or more health service providers to which it provides funding to integrate, subject to restrictions per S.26(2) Per S.27(1) Integration between another person or entity Per S.28(1) based on advice from the LHIN and deemed to be in the public interest 11

12 Notice of Voluntary Integration If a health service provider wishes to integrate its services with those of another person or entity and if the proposed integration relates to services that the LHIN funds (in whole or in part), the health service provider must first give notice of the proposed integration to the LHIN ( Notice of Integration ). The Central East LHIN has defined Notice requirements see If the proposed integration relates to services that are not funded by the LHIN, then no such notice is required and the health service provider may proceed with the integration. 12

13 Stopping or Altering Voluntary Integration A LHIN can prevent the integration or a part of it from proceeding if it has concerns about it. In doing so, the LHIN would follow this process: The LHIN would, within 60 days of receiving the formal Notice of Integration, provide the health service provider with a notice that it proposes to issue a decision ( Section 27 Decision ) ordering the health service provider not to proceed with the integration or a part of it. The LHIN would provide the health service provider with a copy of the proposed Section 27 Decision and would make a copy of it available to the public. When the LHIN issues a proposed Section 27 Decision, a health service provider or any other person may make written submissions about it within 30 days of the LHIN making it available to the public. This provides an opportunity for any interested party to provide input to the LHIN. 13

14 Stopping a Voluntary Integration If the LHIN does not provide the health service provider with a notice that it intends to issue a Section 27 Decision, the health service provider must wait until 60 days have passed since the health service provider gave the formal Notice of Integration to the LHIN before proceeding with the integration. If the LHIN does provide the health service provider with a notice that it intends to issue a Section 27 Decision, the health service provider must then wait until 60 days have passed since the LHIN gave that notice. If the LHIN issues a Section 27 Decision, then the health service provider must not proceed with the integration and must comply with the Section 27 Decision. 14

15 Altering a Voluntary Integration The LHIN may set conditions on the integration; that is, order the health service provider not to proceed with the integration (or a part of it) unless certain conditions are met. If the LHIN issues a Section 27 Decision ordering a health service provider not to proceed with a part of the proposed integration or if the LHIN sets conditions on the integration, the health service provider may choose not to proceed with any part of the proposed integration. A LHIN s decision not to stop a proposed integration concerning LHINfunded services does not prevent the LHIN from facilitating or negotiating the integration nor does it prevent the LHIN from issuing a decision requiring the parties to undertake certain integration activities in relation to the proposed integration. 15

16 Voluntary Integration Decision Flow HSP gives formal notice to LHIN that it wishes to integrate funded services LHIN does not issue a proposed decision stopping integration Within 60 Days LHIN considers HSP notice LHIN issues proposed decision stopping integration. Section 27 decision LHIN may negotiate/facilitate the integration, and put forward changes LHIN Considers any submissions; may change or confirm proposed integration decision Within 30 Days Integration may proceed LHIN does not issue a final decision stopping integration LHIN issues a final decision stopping or putting conditions on the integration. S.27 Integration may NOT proceed 16

17 Decision Making Framework - Overview The LHIN Priority Setting and Decision Making Framework provides a common tool across all LHINs with consistent criteria to facilitates transparency and accountability in LHIN priority setting and decision making processes, such as allocation of funding and integration see 17

18 Decision Making Criteria System Alignment Alignment Strategic Fit System Performance Sustainability Integration Quality Access System Values Equity Efficiency Client Focused Innovation Partnerships Community Engagement Population Health Health Status Quality of Life Health Promotion and Disease Prevention 18

19 Scarborough Hospital Alliance Discussion TSH-TEGH ALLIANCE RATIONALE 19

20 Central East LHIN Involvement The CE LHIN applauds all integration efforts that aim to improve patient experience and generate greater efficiency/value-for-money of the health system. To date, the CE LHIN has neither received a formal proposal for voluntary integration, nor a formal notification from either hospital on the details related to this integration activity. The CE LHIN has requested formal documentation of the community engagement plan. This has not been received. The CE LHIN posses informal information shared through management channels, media and a recent Town Hall meeting. 20

21 TSH TEGH Alliance Timeline August 2011 TSH advises CE LHIN of preliminary discussions with TEGH re: administrative partnership October 2011 media coverage of Alliance discussion joint messaging from TSH and TEGH provided speaks again of administrative and back office functions being explored November 2011 LHIN is advised that TSH and TEGH project team has done initial analysis but that the full nature of the merger between the two organizations, if any, has not been determined January 2012 LHIN is advised that a third party has been retained to validate, review and refine the high level analysis that has been conducted so far. The third party is helping to answer the question of can and should further merger discussions be analyzed. When available, the report will be presented, and based on the findings, a decision on next steps will be made. Originally proposed as exploration into an Administrative alliance, it is clear that from the outset this is being pursued by both TSH and TEGH as full merger of operations (including administration, clinical services and governance). 21

22 TEGH TSH Criteria for Merger Decision Making Criteria Mission compatibility Strong historical relationships Savings potential Cultural change challenges Similar practices Willingness to partner voluntarily Complimentary services Shared, contiguous communities Platform for advocacy Geographical location Continuum of care TSH and TEGH have done an initial analysis of other potential integration partners. At present, it appears that the alliance discussion is only looking at a TEGH-TSH integration option. 22

23 Rationale Provided For TEGH-TSH Alliance Discussions Official Rationale Neither TSH or TEGH has provided an explicit statement of objectives for pursuing this integration, except for statements in the media and other internal communications that it is an exploration to improve service to patients, enable efficiencies, and reduce costs. Public Rationale The Central East LHIN is too big Scarborough not getting the attention and funding it deserves Establish stronger advocacy in the Eastern GTA to complete with Downtown and West and get more funding, attention Will resolve their financial issues No clinical services changes expected. TSH CEO Comments, Feb 9,

24 Scarborough Hospital Alliance Discussions MOVING FORWARD 24

25 Preliminary Analysis Our analysis, based on the information currently available, suggests that a voluntary integration proposal received from TSH would not satisfy our decision making criteria: System Alignment System Performance System Values Population Health Does not align with Clinical Services Plan Direction, the CE LHIN Strategic Directions or LHIN Boundaries Undermines achievements of patient care and operational integration with Scarborough and CE LHIN. No evidence that this will improve quality or access possibly undermine it. Sustainability gains could be achieved through other partnerships. Current activity is not client-focused; Lack of clear engagement strategy; Lack of physician support. No evidence to suggest that merger would assist in addressing population health challenges within Scarborough (e.g., Chronic Disease) 25

26 Other Integration Options Management recommends that any proposed integration opportunity should fully explore all options, including opportunities between RVHS and TSH. RVHS-TSH opportunity at a glance Have sites which are located within near proximity of each other and within CE LHIN. Already partners in successful programs and initiatives that directly benefit the community. Could anticipate stronger support from Scarborough cluster community, municipal and physician stakeholders Similarity of Scarborough catchment areas would allow for both clinical and administrative efficiencies. Leverage each organizations existing strengths to create a stronger organization better equipped to meet the needs of Scarborough. Requires no LHIN boundary changes and streamlines accountability structures 26

27 Central East LHIN Involvement At this time, we are NOT REQUESTING the Central East LHIN Board issue an integration decision stopping a future voluntary integration (Section 27) NOT REQUESTING the Central East LHIN Board issue a directed integration to TSH REQUESTING the Central East LHIN Board place some conditions on current integration activities being conducted by TSH 27

28 Central East LHIN Expectations That TSH fully explore at least four integration opportunities: 1. Status Quo 2. TSH TEGH Alliance 3. TSH RVHS Alliance 4. TSH RVHS TEGH Alliance That TSH improve the transparency of the planning and decision making process, including: Documenting and make publicly available an integration planning document outlining objectives, timelines, and key decision points Identify opportunities for community engagement, including public feedback, at specific junctures of the integration process That the CEO and Board Chair from TSH attend the March 28, 2012 meeting of the Central East LHIN Board of Directors to explain the objectives of any proposed merger and to confirm their next steps. As per the Central East LHIN Delegations to the Central East LHIN Board policy, interested stakeholders will be invited to provide any comments at the March 28, 2012 meeting. Information presented by the delegations will be catalogued by the Central East LHIN and provided back to TSH for their use. 28

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