Could enough savings be found in the delivery of health care in Muskoka through the Muskoka and Area Health System Transformation (MAHST) initiative to keep two hospital sites going?
“Unfortunately the answer to that is simply no,” Evelyn Brown, the chair of the Board of Muskoka Algonquin Health Care (MAHC), which manages both the Huntsville and Bracebridge hospitals, told council at its July 24 meeting.
“The kinds of funds that we’re going to need in the future will not be generated to the extent that I think some of the MAHST folks are suggesting,” said Brown. “I think that what MAHST will come up with is a much better service and program for the residents of Muskoka and beyond. It would be great if that money did come, but however we are still left with old buildings,” said Brown, adding that by the time the capital planning process is done, the buildings will be anywhere from 60 to 70 years old. “I’m not quite assured that trying to upgrade two old buildings will have the funds generated sufficiently but we’re in the early stages. That is just my thinking on it and others have certainly dug deeper but the information that we have is that renovations are more expensive than building new because you can build better and smaller and more efficient for the future… I’m also thinking that keeping old buildings is just not going to be on in the future.”
Brown also said to ensure quality and sustainable health care MAHC needs critical mass. “Now what I mean by critical mass is that we have to have a sufficient number of people coming to the hospital in order to use the facilities that we have. I suppose it’s just like… business, if you don’t have any customers come through the door, you have to start to look, right, at how you’re going to do business differently.”
Brown said MAHC has to ensure that it has adequate operating funds, that it can recruit and retrain skilled health care professionals and reduce the cost of duplication.
“Every year, as of April 1st, when we move into a new fiscal year, just moving people through their salary grid and completing the obligations through the different collective agreements puts us about six to $700,000 in the hole right away. That is not addressed by the funding formula,” said MAHC CEO Natalie Bubela, adding that inflationary pressures along with a funding formula that is designed for single sites has also resulted in hospital deficits.
With a two-site operation you have inherent inefficiencies in that because you’ve got, in some situations, double the programs. If you had them all under one roof, you really could be able to look after the same volumes with less staff. But as soon as you have two different organizations, splitting the volumes between them, it really does raise your staffing costs.MAHC CEO Natalie Bubela
Bubela gave an example, although she was careful to point out that she was not suggesting any particular model. She said Muskoka currently has two emergency departments, which require three nurses to be on night shifts at each to ensure that if one is off on break, there are two in each ER at any given time. “If we only had two staff on, that would mean there would be one staff person left in the department to manage it and that’d be unsafe. As a result, you need to have three staff on site for maybe nine or ten patients that may come in through the night time over and above any other patient that may be still there from the evening or the day that hasn’t been able to get into a bed. If you had one department you wouldn’t need the six nurses,” she said, adding that based on average visitors to the ER, one department could be staffed with four rather than six nurses at two ERs.
Brown said that in 2015 the Board of MAHC chose a one site model for the hospitals, but also reminded council that a year and a half ago, during a joint meeting of Bracebridge and Huntsville councils, a different model was endorsed. “So when we move forward, we want to use some of the data that we have, refresh it, get lots of opinion – the world has changed since 2015 and so we want to review all of that before we move forward,” said Brown, adding that MAHC has been given a grant to move forward with planning for the future.
Bubela noted that the one million dollar grant recently announced by the Ministry of Health and Long Term Care will cover stage one and hopefully stage two of the capital planning process. She said stage one involves program and service planning in much greater detail than before as well as physical infrastructure planning and consultation.
“We do need to refresh our data as Evelyn has indicated. We’ve actually begun that process by rehiring the consultants that worked with us in the past,” she said, referring to RPG as well as Stantec architectural consultants. She said a task force appointed by the Board will look at the various options available and with the help of consultants it will come up with cost estimates to understand the impact the various options would have on the overall operating budget of MAHC, based on the Province’s current funding formula. The second phase of stage one would then be to determine the actual cost of implementing that plan.
Brown said the task force will meet monthly. She also said Don Mitchell, Chair of MAHST, will be the vice chair of the new task force and MAHC Board member Cameron Renwick will be the chair. The task force will make a recommendation on the future hospital model to the Board of MAHC. If the Board approves the recommendation, it will then submit it to the LHIN. That is expected to happen sometime in 2018.
Brown said those who will sit on the task force will hopefully attend the meetings with an open mind to re-evaluate and “help make the recommendation that will serve the communities now and into the future.”
She said the process of implementing a new model for health care in Muskoka could take 10 to 15 years to complete. “It’s a five-stage process that you have to go through and at each of those stages there’ll be back and forth with the government.” She cited Trafalgar hospital in Oakville as an example. “They have a huge, beautiful, million square-foot building. They started that in 2000 and they opened in December 2015,” said Brown, adding that Oakville is a wealthy community with “probably a lot of influence in high places and it still took 15 years.”
Councillor Jason FitzGerald asked whether there’s hope that the Province might change its funding formula, to which Bubela replied that there might be as a result of recommendations from the Ontario Hospital Association at the end of August. “At the same time I would say that the Ministry is strapped. There’s only a certain pie of money that’s out there and changing the formula might mean that you shift to some but you’re going to be taking away from others. I don’t think it would be net new dollars that would be coming into the system so I think that’s a real challenge for the Ministry right now.”
Huntsville Mayor Scott Aitchison said the issue of hospitals is an emotional one “and one of the things that I heard regularly through your presentation was recognition that the funding formula is fundamentally flawed for medium-sized hospitals,” he said, adding that he takes issue with constantly hearing that one of the draw-backs is also that the area has two hospital sites.
“One of the challenges I have with that language is that in fact we have two different hospitals that came together to find ways to save money through cutting cost in administration; who have subsequently found ways to cut cost by single-siting certain chronic care services. Those were difficult things to do… I just feel sometimes instead of looking at it as we’re a hospital with two sites, why we don’t look at it as two hospitals that came together to try to find ways to save money for the Province regularly and continue to do so and at what point do you have to keep cutting before you shut it all down… we’ve done our bit for king and country, how much more do you expect us to do here before we can’t legitimately carry on anymore.” Aitchison stopped short of questioning whether a change of government might mean a different tune.
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