By Hugh Holland
Hospital Planning – 2017
Healthcare planning is one of the biggest challenges in every country. In developed countries, the relentless appetite for money is driven by aging demographics and the ever-increasing list of costly new procedures, technologies, therapies and drugs.
In Ontario, healthcare consumes almost 50 per cent of the provincial budget, leaving 50 per cent for everything else. Yet there are frequent reports of chronic overcrowding of hospitals. The Auditor General’s report stated that (after a three-year freeze) the three per cent healthcare increase in the 2017 Ontario budget was inadequate to address the hospital situation.
International healthcare comparisons sometimes show conflicting rankings based on questionable interpretation of data; however, they can provide valuable insight. The most basic indicator of a nation’s health is life expectancy. Life expectancy is affected by many factors such as heredity, diet, lifestyle, and quality of healthcare. With a few exceptions, life expectancy correlates closely with economic success (GDP per capita). Canada currently ranks 11th among 30 countries with life expectancy over 80 years.
There is an equal mix of public and private/public systems among 20 best-performing countries. Data does not support the popular notion that private systems perform better than public. Life expectancy and costs in the public systems are similar to the private not-for-profit insurance systems. The US private for-profit system is unique and has lower life expectancy and higher cost than the top 20 countries.
Since healthcare per-person spending and per cent of GDP are already higher in Canada than average among the top 20 countries, it seems that improvements here should come from efficiency gains and prudent spending. The current healthcare integration work in Muskoka is a good step in that direction.
That brings us to the ongoing debate on future hospital locations in Muskoka that started in 2014. It’s safe to say that a referendum of the affected populations would clearly favour maintaining the two existing hospitals. MAHC was recently granted another $1 million dollars to re-engage consultants for yet another study. The leadership of MAHC seems to be leaning toward a single new site, but has promised to conduct the study with an open mind.
It is difficult to believe that a single, larger, new hospital with new land and extensive infrastructure requirements would be easier to fund and would provide better care than incremental updating of convenient existing hospitals. After leaving the impressive lobby when visiting my brother in the new Barrie hospital, the halls and rooms looked no different than those in our Huntsville hospital.
In health care, location-location-location really is a primary consideration. In fact it is often a matter of life or death. Huntsville is much closer to both the geographic centre and the centre of populations between the larger hospitals in Orillia and North Bay. But having to drive another 40 minutes from Bracebridge to Huntsville or vice versa would result in a serious setback in effectiveness. The 60-minute winter drive from Burk’s Falls to a more-central Port Sydney location would not be a positive step.
Toronto General was built in 1812, Toronto Western was built in 1895 and Sunnybrook was built in 1943. They have all been continuously updated to meet ever-changing needs. In comparison, Muskoka hospitals are relatively new. Bracebridge was built in 1963 and Huntsville in 1977, and are also updated.
It is instructive to consider the examples of Orillia and North Bay. The Soldiers’ Memorial Hospital in Orillia consists of a group of buildings assembled in 1908, 1922, 1926, 1963, 1970 and 1982 as needs and technologies changed. Yet patients (including my wife who had her hip replacement in Orillia) report an excellent experience.
The new North Bay hospital is the product of an exhaustive 15-year “Master Planning” exercise that closed half of their beds as soon as it opened. Does this indicate that in such a rapidly evolving field as healthcare, small incremental changes might work better than large-scale disruptive change?
Last fall, we had occasion to visit the small, plain-looking 10-bed hospital at Tofino on the west coast of Vancouver Island. The hospital staff, most of which were First Nations people, was so outstanding that my wife felt compelled to send a letter of thanks for the excellent care she received. It is doubtful that beautiful but remote Tofino could function without that hospital. People in Huntsville and Bracebridge feel strongly about “their hospitals” that they contributed so generously to help build and update.
The point is that in health care, customer satisfaction and effectiveness depends more on convenience, timeliness, and the human touch than on the bricks and mortar. And that depends on spending always-limited funds in the right places.
Ontario’s currently posted infrastructure plan shows 12 of 21 healthcare projects in the GTA, with Sudbury as the only project north of the GTA. The MAHC study should consider other philosophies on spacing and size of hospitals, which is very much a part of effectiveness, as well as what goes on inside.
To that end, I would like to suggest that the MAHC study include a two- to four-week visit to hospitals of similar size and age in countries with similar but higher-ranked healthcare systems. Probably the UK and Sweden would be the best bets. That part of the study team should consist of two healthcare professionals from Bracebridge, two from Huntsville, and two from the consultant to organize the visit and to document the findings. Seeing is believing.
Don’t miss out on Doppler! Sign up for our free, twice-weekly newsletter here.
Excellent advice Hugh! MAHC, our Federal and Provincial Govenrnments would do well to adhere to your words of wisdom. Most, in both the Huntsville and Bracebridge area want no less than we have right now.
If necessary, add wings to the existing hospitals to accommodate our future needs. Let’s not overlook the heavy demands on our hospitals with the ever increasing numbers of retiring seniors moving into our area from the GTA. With the ever increasing number of sub-divisions being built, condominiums and town houses being constructed, the locating of a new single site hospital in Port Sydney would be totally unacceptable.
In my career, I had the opportunity to pick up many good ideas from visits to plants in the USA, Europe and Japan. Yes you can get some information from posing questions on the Internet, but you get so much more by seeing. Without seeing, you don’t know what questions to ask.
I thoroughly enjoy reading these comments, each opinion gives so much more to us members of the public that need more information in order to have their own educated opinion.
Number one: get rid of the elitists that consider membership on the Medical Committees to be a social status.
Number two: lets have more comments “from the past” as to the inside workings of these powerful “Boards” the recent comments from past Chairmen about the politics involved were eyeopeners, as were the resignations and ‘firings’? of seemingly well accomplished members that are gone from our local boards.
When the opening comment to Huntsville Council is the negative one ” I don’t see how” referring to one hospital or two, – we don’t need that stuff! Get those two ex-members back if they are needed!
I understand this will be something like 20 years in the making, – this project, – something I probably wont see, so lets cut to the chase, and get going without the old ladies from the south.
(What is it that blue haired ladies seem to represent wise thinking?)
One All inclusive Hospital in Huntsville with an Emergency and elective procedures in Bracebridge’s hide bound location is the number one priority as I see it. Huntsville has all the infrastructure that’s needed, as well as the motel/hotel accommodation for visiting relatives close at hand. Lots of room for expansion over the years.
This is getting lengthy, but one last comment about visitors accommodation. There’s a shortage of Motel/ Hotel accommodation in the halfway location, Port Sydney , what Chain is going to build one for hospital visitors only, or do we tell people there’s accommodation and restaurants a few miles up or down the snowbound highway.
This nonsense of do we build another hospital here, or do we build another hospital there is getting to be a big pile of garbage.
Complaining that there’s not enough money for proper health care facilities.
The down to earth truth is that we pay hospital officials way too much salary and don’t generate enough money to pay for it.
As a visitor to the hospital’s E.R. department in the last few weeks has told me one thing. We beef to increase the facilities where they are, and not move them.
How many people realize that this hospital in Huntsville Ontario had a third floor that was in the plans to be built years ago.
There’s also enough property to build extra out buildings e.g. possibly nursing homes, or other treatment services.
That on the second floor of the hospital they had an entire wing shut down to add offices and clinics.
In fact two of the rooms lost in that shuffle were dedicated rooms for children with a play room across the hall.
There’s also enough property to build extra roads to the hospital from Hanes road and highway 60 giving better access instead of just one in and out.
The big wigs also neglect to realize that this hospital in Huntsville services all the highway 60 corridor into Algonquin Park, plus small towns to the north of Huntsville.
We have lost a small hospital in the town of Burk’s Falls Ontario that was the midway point in between Huntsville and North Bay.
People who have to live inside those areas already have a 20 minute plus drive to get to an E.R.
How many heartaches have people had just because the loss of it?
If this hospital in Huntsville Ontario gets shut down and moved in between Huntsville and Bracebridge it will mean longer traveling times to get to a health care provider.
People complain that the hospital parking lot rates are also high and that we should be able to park for free.
You spend $7.00 for parking at an Ontario owned hospital on average but pay absolutely nothing at the province’s casinos.
There’s something wrong with that I feel.
If we started charging parking at gambling venues across the province and directed the revenue to health care facilities wow we might have something.
An incisive perspective, Hugh. As a European and Canadian citizen, I back your suggestion to visit Scandinavian health care facilities to map their efficient, cost-effective local delivery in districts similar to ours. Many donors, dedicated volunteers and practitioners have built warm, excellent local services that mustn’t be relinquished for an arbitrary centralising paradigm.
Totally agree with Mr. Stehr on the time factor, and while visiting European countries to observe and study their health care facilities is admirable, the cost is prohibitive! With the internet, all questions could be answered by the contributing countries as to pros and cons of their system, thereby eliminating yet another yadda, yadda delay in the decision making process, which has gone on far too long at this point already. Spend that travel money on more local needs and get to the bottom line, at last.
It is always prudent to do extensive research when contemplating any project but especially important considering the magnitude and importance of health care in Muskoka.
If this should bring us to similar sized towns in Europe so be it. Europe has many facets of their infra-structure and lifestyles including health care that are superior to ours i.e. subway systems, airports, train systems, city and town planning, green spaces, paid university, large downtown walking areas (read no cars) highways and hospitals, the list goes on and on.
Having visited Europe over a 40 year career with Air Canada one big difference that must be considered is the huge differences in distances between towns and cities here and there. The time it takes to drive from Huntsville to the GTA can be the same time that it would take you to drive into 3-4 countries in Europe.
The distance to get to a hospital here in Muskoka is even more important than any ranking. You can have the very best hospitals in world but if the distance to get to them means dying in an ambulance on route then its all for not. “TIME” is one of the key factors in having proper healthcare in the vast areas of Muskoka and points beyond that are currently served by our two, not so perfect, but very functional Muskoka hospitals.