Report on the future of health care delivery in Muskoka does not address hospital locations

While a more enhanced health care delivery system is welcomed, taxpayers want to know how far they will have to drive if a medical emergency hits.

Where do the hospitals fit into the big picture of health care delivery in Muskoka? That is what representatives of the Muskoka and Area Health System Transformation (MAHST) initiative were asked when they went before Huntsville Council at a special meeting Monday. Their visit to council came on the heels of an announcement released Friday by Muskoka Algonquin Health Care, which manages both the Bracebridge and Huntsville hospital. MAHC stated that it had been given approval by the Ministry of Health and Long-Term Care to proceed with its hospital capital planning process for both hospital sites and given $1 million in grants to do so. In its release, MAHC indicated it would be creating a task force to look at the hospital issue and MAHST would be at the table. But the fact that MAHST was created in response to the hospital board’s decision in 2014 to move to a single hospital site, instead of the existing two, was not lost on anybody.

“The elephant in the room is… will acute care and emergency services remain in Huntsville?” asked Huntsville Councillor Bob Stone. He said he thought MAHST would be making that decision as part of its attempt at transforming health care in the area. “I thought the composition of MAHST was broad enough and the objective in part was to make that decision. Now I understand there’s supposed to be a new task force created where MAHST will have a seat at it, but they will ultimately decide if we have emergency services here. Was the objective missed as part of MAHST?” he questioned.

Rob Alexander, the north Muskoka and area representative on MAHST responded: “In terms of our deliverables, it [future of hospitals] certainly was a piece of it but it wasn’t what we were tasked with doing which was this transformation model.”

Huntsville Mayor Scott Aitchison asked whether MAHST could find enough savings to fill the funding gap associated with the hospitals. “And further to that, if in fact that funding gap is made up by these savings, does MAHC feel like there should be two acute care sites in Muskoka or at least, you know, does that change their thinking?”

Alexander said that he personally does think that enough money could be saved through MAHST’s initiative to fund acute care shortages. “I think what might end up being our acute care sites – they will be local – but what they look like will be fundamentally different, honestly, than what we currently see by the time we get to 25 years,” he said, adding that there isn’t a consensus on how to move forward with the hospital model at this point.

Former Board Chair for MAHC Larry Saunders said when the organization started the capital planning process in 2013/14 it was due to aging infrastructure and the fact that the hospitals were continually underfunded.

“We felt that we had to re-look at the way we were defining health care in Muskoka and MAHC and come to an understanding of what we want it to look like in 25 to 30 years,” he said. “We’ve got a ten or 11 million dollar deficit, or loan at this point in time for our hospitals. We need to get MAHC in the queue for consideration on a five-stage capital planning program that the Province has, which is a 25-year exercise.”

Saunders added that the work that MAHST has undertaken so far will inform initial capital planning for the hospitals. He also said technology will play a huge role in that decision. “You know they’re using iPads now to do diagnosis in homes [and send] back to the doctor’s office. Change will happen in ten years, that’s outstanding. We may even have self-driving cars at that point in time that we don’t have to worry about transportation. You’re driving the car [and you’ll say] take me to the hospital. We don’t know what’s coming but it is part of a planning process and the two processes [MAHC’s capital planning and the MAHST initiative] have to work together going forward if we’re going to get any kind of result and have hospitals here for me when I get ill because if I get older I’m going to get ill. That seems to be a way of life.”

Aitchison noted that his question had not been answered as to whether the hospital board would favour two acute care sites if savings are found.

Saunders, who is also a Director on the Board of the North Simcoe Muskoka Local Health Integration Network (NSM LHIN), which plans, integrates and funds local health care dollars for the Ministry, responded that there isn’t an answer at this point.

Aitchison said that while he can appreciate that technology is changing everything including health care and perhaps the duration of hospital stays, the need for emergency care and one’s proximity to that life-saving care is important and probably will be 25 years from now, as well.

“I agree with that but will the emergency room be the same way that it is today 10 years from now? Can it operate on the back of a paramedic’s vehicle…” questioned Saunders. “We couldn’t touch a large trauma case anyway because the big orange helicopter comes up and takes them,” he said, referring to air ambulance transportation to other health care centres particularly in the south. Saunders said the work that MAHST has done has given MAHC “tremendous insight on what is going on today and what are some of the things that we could be doing for not only patients but providers… there are no definite answers. We have a road map. We have a road map that we’d like to follow; we believe that it’s right. If someone has better ideas, we’d love to have them because we’ve had tons of discussions and this is our way forward and now it’s up for discussion and debate,” he said.

MAHST is touting a more cohesive model for health care delivery in Muskoka, one which they say would eliminate duplication, decrease administration for the estimated 30 health care providers in the area, attract more physicians to the community and make it easier for the patients to navigate the system while also ensuring that they have access to primary care providers and all while saving money. MAHST is also asking politicians to lobby the Province to ensure that savings found in the system through MAHST would be redirected to front line health care in the community.

MAHST will also be seeking approval to incorporate a new entity which would co-ordinate and direct local health care delivery in this region, as part of its plan. They will also be petitioning the Ministry and NSM LHIN to expand the agency’s boundaries to include areas such as Burk’s Falls in this LHIN. They’ll be presenting their plan to the LHIN and asking for funds to implement the plan, rumoured at an estimated $820,000. They’ve asked for municipal support and are expected to make their pitch to the LHIN on July 24, but the LHIN is not expected to make a decision at that time.

Huntsville Council may also have a resolution on the issue at its next council meeting, which will also take place on July 24. It first wants to hear from MAHC and meet with mayors and reeves north of Huntsville, a meeting scheduled for July 17.

In the meantime, Aitchison asked what would happen if the LHIN does not approve MAHST’s funding request in order to begin putting its plan in place.

“If we don’t get funded, I think there’ll be a lot of questions to be asked,” said MAHST chair Don Mitchell. He said the Ministry of Health issued the LHIN a mandate letter, which is closely connected to MAHST’s vision. He said if the LHIN does not support what MAHST is proposing there will be questions for both the LHIN and the Ministry of Health. He said he’s pretty sure there will be support, what he isn’t certain about is the level of support. “Will we get funding? I’m sure we’ll get funding and I’m sure we’ll be continuing on,” he said. You can find the report submitted Monday to Council by MAHST, by turning to page 2 here.

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