MAHC posts Q&A in response to hospital task force public meeting

The Capital Plan Development Task Force met on February 26, and held a public consultation meeting on March 1 to invite delegations to receive comments and ideas from the public regarding MAHC’s future planning. Approximately 140 people attended the meeting and 16 people from across the region presented their comments. The task force also received nearly 100 written submissions that are also being distributed to the MAHC Board of Directors.

During the March 1 meeting, it was evident to the task force that people are very passionate about future acute care planning. Some of the recurring themes heard from the various speakers included:

• Access to care, especially emergency care is important
• Two full service “status quo” acute care sites is the community’s preferred model
• There is a willingness to support renovation of existing facilities over a number of years versus a new build
• The Ministry of Health and Long-Term Care needs to adequately fund MAHC operations
• Community hospitals have a unique role in promoting economic development and sustainable communities
• People, businesses and other health care agencies chose their physical whereabouts based on existing hospital locations

In response to questions raised during the meeting, a Q&A has been posted on the MAHC website to also correct statements that were made. The task force thanks everyone who provided feedback, and appreciates the public engagement both in person or by watching the YourTV footage virtually. (Note: the video is only available online until March 31, or watch it on the full coverage is also available on YourTV On Demand found on Cogeco Channel 602.)

[For ease of reading, Doppler has included both the YourTV video, while it is available, and the Q&A as posted on the MAHC website below.]

The task force further noted cynicism and skepticism about the capital planning process and whether public input will be listened to. The task force is committed to a comprehensive review of data and analysis of the various options, and emphasizes the importance of public feedback and community support. Task force members will consider all public feedback received when evaluating the models and recommending a preferred model to the Board of Directors.

The next task force meeting is March 19, 2018.

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Your Questions Answered (as posted on the MAHC website on March 16, 2018)

A Q&A has been developed to answer a number of questions posed and to clarify information with respect to statements that were made during community consultation in March 2018. (YourTV video from that meeting is shared below.)

Why is One Hospital model still being discussed when people have spoken against it?

The Ministry of Health and Long-Term Care has directed MAHC to further explore the three models proposed and evaluated in 2015, including the One Hospital model. The Ministry stipulated this in the planning agreement for Stage 1. MAHC has asked the North Simcoe Muskoka LHIN and the Ministry if they have a preferred model, or if any models can be taken off the table. To date, the response has been to further explore and evaluate all three models to ensure all options have been thoroughly researched and evaluated. MAHC has deliberately focused on developing the two different two-site models first in our current work before developing the One Hospital model.

Fix the funding formula and MAHC money problems will be solved. MAHC’s financial situation can be fixed with the stroke of a pen.

The Ministry is examining the challenges posed by the provincial funding formula for hospitals and more specifically the impact on medium-sized hospitals. MAHC believes that the funding formula does not consider the operational needs of a multi-site operation. MAHC continues to advocate to the province for a long-term sustainable financial solution and improvements to the funding formula. The government introduced Health System Funding Reform in 2012, which significantly changed the way that hospitals across Ontario are funded. Given the provincial deficit situation, and realizing that health care costs cannot continue to grow at the expense of other vital provincial programs like education and social services for example, the Ministry introduced a funding model that encouraged more efficient delivery of services and treatments through a patient-centered funding model where funding is based on the services provided and the patients served. The funding model uses evidence to inform health spending so that money follows the patient and drives quality improvement. The government is also shifting health care dollars to health care provided in the community. Learn more.

It is shameful that the hospital has not stayed within budget.

Since 2010-11, MAHC has achieved five balanced budgets. Fiscal year 2015-16 was not balanced and the deficit was $1.6 million. Fiscal year 2016-17 was another balanced budget and we are hoping 2017-18 will be too. One-time funding and annual funding increases from the Ministry of Health and Long-Term Care have been critical to achieving a balanced position. MAHC is continually challenged to balance the annual budget because of rising costs through inflation on things like hydro and gas, supplies and drugs, in addition to annual salary increases for point-of-care staff mandated by collective agreements. MAHC believes the organization is underfunded and that Health System Funding Reform (funding formula) disadvantages MAHC because of the multi-site operation and designated “medium” size, and continues to advocate to the province for a long-term sustainable financial solution.

Has the Task Force considered studies on distance impacting mortality rates?

A number of studies have been examined and others were referenced at the March 1 meeting. These studies are being gathered and shared with the task force members so that they have this information.

Won’t people die if we change the hospitals?

Any plan we put in place will be focused on providing high-quality, safe, sustainable health care. There are no standards or ministry guidelines on travel distances, and distances to emergency departments vary across the province but there is no doubt travel distance is important and needs to be considered. The Task Force will carefully examine this factor, including travel distances to emergency care. In some situations, you are better to travel a little further to a specialty centre, than to the closest facility where the services you need may not be available. There is a balance to be struck and this is being factored into the model discussions. Currently, only 60% of the inpatient care you need gets provided in Muskoka, while 40% of patients get this care outside of Muskoka. Many of these admissions to other hospitals are for the most serious of medical needs, trauma, heart attacks, strokes, badly broken bones, etc. MAHC stabilizes you and gets you to the care you need. In some cases, ambulances bypass hospitals to get you to a specialty centre, like what happens today with stroke patients in Muskoka (South Muskoka and West Parry Sound stroke patients bypass the closer facilities to get to specialized care at the District Stroke Centre in Huntsville). This will also happen with certain types of heart attack patients in the near future when Royal Victoria Regional Health Centre opens its regional cardiology intervention suites.

The One Hospital model is the most expensive of the three models.

In 2015, the One Hospital model was costed as a complete new build. The other two models were a combination of new build and renovation. 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 is 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. Detailed costing of renovation versus a new build will be completed once a specific model and approach are selected. 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

From an operating standpoint, the One Hospital model would be the least to operate.

What is the capacity for building onto each site?

Neither of the two hospital building sites has the structural capacity to build up additional floors upon existing ones. The South Muskoka site is further challenged to enlarge its footprint.

There aren’t government standards for hospital infrastructure.

Health care standards constantly evolve. One reason MAHC is planning for the future is because the buildings do not meet current standards. Based on today’s health care planning guidelines and infection control standards, a hospital should comprise 80% single occupancy rooms. MAHC had to renovate the Dialysis Unit in 2012 because of a requirement for greater space between patients and the requirement for an isolation room so patients with infection could be treated without putting other patients receiving the same care at risk. Renovations to the Chemotherapy Clinic also required greater space between patients and required the clinic to nearly double in size.

For Pharmacy alone, there are more than 450 new standards, a number of which are specific to buildings/infrastructure, such as: requirements for surfaces to be non-porous, non-shedding, smooth and free of cracks, cleanable and disinfectable; requirements for HEPA-filtered air exchanges; separate rooms for hazardous and non-hazardous drug compounding, as well as rules around narcotic security.

Do renovations of current facilities require bringing the buildings up to code or is it just newly-built facilities that need to meet current building code?

If you renovate an existing building, the renovated space must meet the current Ontario Building Code as well as health care standards that are required. These standards exist to ensure public/patient safety and high-quality care.

A mega hospital cannot support Muskoka’s needs. It would provide fewer services than two separate hospitals.

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 hospital 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.

We don’t know what health care will look like 15 years from now so how can you plan for that?

Yes, it is difficult to plan for the future, and we suspect that is why the Ministry makes you go through many stages for capital planning where plans get re-examined and updated along the way based on changes in the local community, technology, health care standards or best practices, or building standards. We do not have a crystal ball, but we are committed to updating and revising the capital plans at every stage in the process.

Why are you planning to 30-year horizon? It was 5, 10 and 20 years in 2015.

The Capital Branch of the Ministry of Health and Long-Term Care has recently changed the planning horizons for Master Program (programs and services to be provided) to require plans for 5 years, 10 years, 20 years and 30 years from the date of planning. The Master Plan (the bricks and mortar required to house the programs and services to be provided) has to look ahead 50 years. These planning horizons are the standard horizons to be used for capital redevelopment projects throughout the province.

The amalgamation was driven by a provincial restructuring commission.

The amalgamation was not driven by a provincial restructuring commission. The Board of Directors for both Algonquin Health Services (Huntsville District Memorial Hospital & Burk’s Falls District Health Centre) and South Muskoka Memorial Hospital voluntarily explored an amalgamation. It was self-directed and officially completed in 2005 when Muskoka Algonquin Healthcare was created as one hospital organization with two sites.

Amalgamation did not achieve the promised administrative savings. The hospitals should be de-amalgamated.

Through amalgamation in 2005, MAHC has saved $4 million in annual costs, including significant savings from reducing or eliminating duplication at the three sites. However, MAHC continues to face ongoing deficits as a result of rising costs and declining revenues. De-amalgamation would mean duplicating a number of costs and the same challenges that MAHC currently faces would still be there.

The consultant’s travel data is wrong.

The travel data completed by Preyra Solutions Group that is posted on the MAHC website titled “average travel time to nearest hospital” is correct. The areas of Wahta First Nation, Moose Deer Point First Nation and Georgian Bay are closer to other hospitals (West Parry Sound Health Centre, Georgian Bay General Hospital, and Orillia Soldiers’ Memorial Hospital) than they are to either of the existing MAHC sites, which is why you see the same number for distance. Regardless of potential other locations for MAHC, those areas are still closer to another hospital and therefore the travel times are unaffected.

Applicants to the Board of Directors are vetted to ensure they agree with the One Hospital model.

The MAHC Board Directors are selected for the skill base they bring to the table. During interviews in 2017, candidates were asked an open-ended question: “In 2015, the MAHC board voted in favour of a single site for our future hospital development. How do you feel about our previous decision?” This question was asked not to rule out candidates who opposed the decision, but to determine whether the candidate had familiarized themselves with future planning and other issues and challenges facing MAHC.

Administration staff get bonuses while other salaries are cut and staff are laid off.

No staff member has had a decrease in pay for performing the same role. Many staff belong to unions that negotiate collective agreements that mandate annual salary increases. There are no bonuses paid at MAHC. All senior executive salaries in the broader public sector were frozen by the Province of Ontario in 2010. In 2011 all hospitals were required to implement a Pay-at-Risk compensation structure under the Excellent Care for All Act where part of a senior executive’s compensation was subject to a Pay-for-Performance plan. This program is not a bonus or additional pay. It is a pre-determined sum of dollars that is removed from the agreed-to salary and is only paid if the senior executive meets the goals/targets outlined in their personal business commitments. It is only in the last few months that the provincial government directed a process to change senior executive salaries in line with the executive compensation framework posted on our website.

We can not afford what is being proposed.

Regardless of the model selected, the project will cost hundreds of millions of dollars over time. The Ministry pays approximately 90% of the building’s capital cost, while the community is expected to cover a local share (approx. 10%). The community is also responsible for other costs, such as new equipment and furnishings, which can cost as much or more as the local share.

It will be an astronomical cost to put the hospital in Port Sydney.

The cost to build one hospital in any location was estimated in 2015 to cost approx. $375 million including furnishings, equipment and parking areas. Municipal services costs were not included. These could be substantial (in the tens of millions of dollars) but if it were determined possible and appropriate, even with these costs included it could still be less than the redevelopment costs of the existing sites. MAHC is working with the District of Muskoka to better understand this impact.

It would cost less money to renovate the existing buildings than to build new. A staged approach to redevelopment is possible.

The architects’ work and previous experiences has indicated advantages and disadvantages to renovations: one advantage of renovation over a new build is that it can be phased over a period of time. The disadvantage is that it can negatively impact the ongoing functioning hospital by interrupting service and by requiring work arounds to ensure infection control guidelines and work flow, to mention a few, is not compromised. Renovations can lead to higher costs due to phasing, infrastructure upgrade costs, and clinical process changes. It can also lead to planning and design compromises, which could have a negative impact on clinical and operational performance. In 2015, the One Hospital model was costed as a complete new build. The other two models were a combination of new build and renovation. 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 stress, patient disruption, wayfinding, infection control issues, etc. Detailed costing of renovation versus a new build will be completed once a specific model and approach are selected.

Ontario has one of the lowest rates of acute care beds per capita.

While that may be true, Muskoka does not have a lower per capital number of beds relative to other similar communities. MAHC currently has 96 beds (80 acute care beds and 16 complex continuing care beds) and the current future planning work proposes to increase the number of beds to a total of 157 by 2031.

Foundation donations are down 43%.

It is unclear where this information was sourced. The Huntsville Hospital Foundation indicates it is seeing steady growth year to year in fundraising. Unfortunately when comparing years, a $1 million donation in 2015 would make it appear that in subsequent years there has been a decline. The South Muskoka Hospital Foundation believes it is fair to say that major gift donors are hesitant to offer future financial support until the future planning direction is clear. The South Muskoka Hospital Foundation recently completed its successful Get Better capital campaign, and through this major gift approach many donors are at the end or have already completed their pledges.
This context is important to fairly and objectively compare year-end numbers.

The purpose of asking for a change to the LHIN boundary to the north is to justify the geographic centre of catchment area.

MAHC did not make the request for a LHIN boundary change. This recommendation came from the separate Muskoka and Area Health System Transformation work.

Why is it that Task Force meetings are not open to the public?

The format of the Task Force meetings ensures open dialogue where members are comfortable having frank discussion and exploring ideas and issues. This is not to be secretive, but is to avoid the risk of discussions being taken out of context and shared broadly leading to misinformation, or concepts that never come to fruition having to be explained and defended. It is not unlike municipal councils discussing things in a closed session until a decision point can be reached. A meeting summary is shared with media and posted on the MAHC website following each meeting.

Why was the March 1 public meeting held in Bracebridge?

The Task Force followed an approach that was not unique to consultation on regional matters in Muskoka. The District Council Chambers venue was offered the capability of live streaming. It was unfortunate there were technical issues that evening, but YourTV has generously made their coverage available on their website at www.your.tv/Muskoka until March 31, 2018. Written submissions were also invited so there was no barrier to providing comment. Focus groups are also being used to achieve stakeholder input.

Health Hubs should not operate only during normal business hours.

Health Hubs do not fall under MAHC’s operation. They are under the accountability of the family health teams, and as a result we are unable to comment on when they should be in operation.