On February 28, 2018, Doppler posted a letter to Muskoka Algonquin Healthcare (MAHC)’s Capital Plan Development Task Force from Jean Bagshaw, a retired registered nurse. In that letter (which you can read here), Bagshaw raised 13 points that she felt would allow the task force and MAHC’s board and administration to “have a productive relationship with the public.” We received the below reply from MAHC CEO Natalie Bubela today, March 21, 2018 — her answers are in bold text.
Dear Jean and readers,
Thank you for your insightful letter about the work to plan the best option for future acute care services in the region. The questions you raised and your suggestions have not been taken lightly. We appreciate the need for the public to have answers to the questions you raised.
1. Be perfectly honest with us and tell us the hard facts with as little health jargon as possible; this means explaining that there has not been sufficient funding to meet operating costs for many years, that small to medium-sized hospitals province-wide have been pleading their case to the Ministry of Health for years to no avail, that if the ministry was interested in adequately funding us, they would have changed the funding formula and they would have increased base funding, neither of which they have done, instead giving only one-time bailouts which do not meet our needs and have to be repeated every year.
There has not been sufficient provincial funding to cover the cost of MAHC’s operations and we expect this to continue into the foreseeable future. While the Ministry of Health and Long-Term Care has provided both recurring and one-time funding to MAHC over the years, MAHC is continually operating from a deficit position. MAHC is part of a group of hospitals advocating for changes to the provincial funding formula, but even with changes to the funding formula MAHC expects ongoing operating challenges that are compounded by duplicating services at two sites.
2. Explain that over the years many patient care beds were closed to try and meet budgetary constraints and live within the financial parameters set by the government, so it is not so much a question of space and rooms, as it is the wherewithal to operate them.
There is information on the MAHC website about funding reform and each budget year since 2013. Due to budget challenges, over the past five years MAHC has had to:
- Single sited chemotherapy, ophthalmology and bone densitometry;
- Introduced gynecological surgery as a new service and revenue opportunity;
- Closed 10 acute care beds, then added 5 beds;
- Removed eight Complex Continuing Care beds from the regional CCC program;
- Moved 12 interim long-term care beds to the community as they do not belong in a hospital;
- Reduced 37.3 full-time equivalent positions. Through the labour management process, there were No involuntary exits from MAHC;
- Laid off seven PSWs. All seven were recalled into other positions at MAHC as work became available following their layoff. Not all chose to return.
3. Whenever a speaker or a writer adds an “s” to the word “hospital” and talks about keeping their town’s hospital, clarify that we have ONE hospital organization called Muskoka Algonquin Healthcare (MAHC), with two buildings; this happened several years ago when the two hospitals amalgamated; this is not just semantics as it makes a tremendous difference in how a person perceives the issue; to let people continue to believe that they still have their “own” hospital is to encourage them to live a fantasy that does not exist.
In 2005, the Board of Directors for both Algonquin Health Services and South Muskoka Memorial Hospital voluntarily initiated an amalgamation of the hospitals in Huntsville and Bracebridge, creating Muskoka Algonquin Healthcare. For nearly 13 years MAHC has operated as one hospital organization with two sites.
4. Do not be afraid to make it clear that no matter which option we pursue, we will end up with acute care services in one location; if we divide services between two sites, the site that has surgical services will be the acute care site; if we have one in-patient site and one outpatient site, the in-patient site will have acute care services; if we have one new build on a new site, it will be the acute care site.
There are three models being explored. Only one of the models proposes to locate all the inpatient (acute) services at one site and all outpatient (ambulatory) services at the other site. This model also includes emergency services at each site. The “Two Sites – Not Status Quo” model provides acute care services and emergency services in both sites’ space, although the specifics of what is contained at each site is still being finalized. The task force continues to refine the models based on feedback from stakeholders, including the public. The “One Hospital” model proposes to combine all of the programs and services into a single location.
5. When people express the belief that a new build will be far more expensive than refurbishing two old buildings, answer that statement immediately with facts as you know them to date.
The 2015 costing of building the models as presented to the Ministry in the Pre-Capital Submission demonstrates:
- Two Acute Care Sites would cost $475,479,414 through a combination of new build and renovation
- Centres of Focus would cost $373,301,295 through a combination of new build and renovation
- One Hospital would cost $348,985,661 as a complete new build
The base costs for renovations are less than new construction (in simple terms, you don’t have to build new walls or a roof), but the more complicated the project, the less this is true and costs of renovations quickly start to approach those of the new construction, and can sometimes be more. Hospital redevelopments are complicated projects. When renovating a hospital there are significant costs associated with phasing, project duration, temporary spaces, infection control management, decanting, unforeseen conditions (what’s behind the wall), replacing systems while still using them, etc. all of which drive the renovation costs. There are also the non-monetary costs that need to be factored such as staff impact, patient disruption, wayfinding, infection control issues, etc.
6. When people say that you are trying to build a Taj Mahal that we don’t need … answer them with an explanation of what you have in mind.
There is no talk by MAHC to create a “mega hospital”. We are planning for the same number of programs, services and beds in all of the approaches. The square footage that would be planned for a one hospital model would be less than the combined total for a two site model due to less duplication. Regardless of the model, future planning will provide more services in Muskoka through the proposed addition of stroke rehabilitation beds and an MRI machine.
7. When others say that there is no need for private patient accommodation with ensuite bathrooms because this is not a five-star hotel, give reasons for why this would be included in a new build.
The Ministry’s capital planning requirements require that 80 per cent of new hospital construction for Medical/Surgical beds is single patient rooms with their own washroom. This is not to create a hotel environment, but is to protect patients from infection. It is hospital safety best practice that patients do not share bathrooms and can be isolated from others when necessary.
8. When some say that it is impossible to build a new hospital in the boonies where there are no municipal services, address the topic openly and thoughtfully.
There are significant challenges and costs to building outside of designated urban centres where municipal services are not available. The Task Force is exploring the impact this would have on local economies and on land-use planning for all of the models.
9. When a writer talks about towns that are not within the Simcoe-Muskoka Local Health Integration Network (LHIN), tell them about the LHINs and their regions and how the distribution of funds affects decision-making at the LHIN level, and why our LHIN might not be concerned about health care in locations for which they are not responsible.
MAHC is planning for the acute health care needs of the MAHC catchment area, which includes the District of Muskoka and portions of East Parry Sound. While Georgian Bay is part of the District of Muskoka, the majority of their population accesses other hospitals. MAHC belongs to the North Simcoe Muskoka LHIN. The LHINs are responsible for planning, integrating, providing and funding health services not only for hospitals, but for home and community care, community health centres, long-term care homes, mental health & addiction programs, and community support services agencies within their boundaries. This map shows that the East Parry Sound communities that access MAHC services are not within the NSM LHIN boundary, but they are very much considered in MAHC future planning.
10. When someone who has been classified as a “senior” voices an opinion or asks a question, show them respect and understand that even though they themselves may not be here to benefit from future health services, they nevertheless care deeply about their town and the health care services available to those who live in that town or visit it.
MAHC values all opinions and is receptive to all voices.
11. The task force needs to reveal where any new build would be located if they expect people to be able to get onside with that option; it is impossible for anyone to even consider that choice without having a clue where it will be built (i.e. within a 20-minute drive from both or a certain number of kilometres south of Huntsville and north of Bracebridge).
The planning work to develop the models includes discussions on siting. Detailed information about the programs and services in each of the models, where the models could be located and how they could be built will be shared once it is completed.
12. If talking about a site A or a site B, or an outpatient site and an in-patient site, they need to declare which site will be where.
Workshops with stakeholders are occurring to develop the models and include discussions on siting. Detailed information about the programs and services in each of the models, where the models could be located and how they could be built will be shared once it is completed.
13. And finally, if the decision has already been made, then they need to have the courage to tell us that, with the reasons for it.
No final decisions have been made. The Task Force is overseeing a new chapter of MAHC’s future planning work. MAHC has asked the LHIN and the Ministry if they have a preferred model, or if any models can be taken off the table. MAHC has been directed to further explore and evaluate all three models to ensure all options have been researched. MAHC has deliberately focused on developing the two two-site models before developing the One Hospital model.
Natalie Bubela, CEO
Muskoka Algonquin Healthcare
MAHC also shared a media release today regarding a list of Q&As on its website. You can read it here.
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