Making a recommendation on a future hospital model that the community can get behind is a daunting task.
That’s what the 25-member Capital Plan Development Task Force has been asked to do and they’re expected to deliver their findings to the hospital board sometime this spring. The Board will then consider whether to move forward with that option and submit it to the Minister’s office for approval. But until that happens, a significant funding request recently pitched by the chair and vice chair of the hospital board to a District committee will likely be on hold.
On January 19, 2018 the group approached the District’s Corporate and Emergency Services Committee in anticipation of District’s budget deliberations. It told committee that it would take a whopping $48 million just to keep the doors open at both the Bracebridge and Huntsville hospital sites, three to five years down the road. But that wasn’t all; their biggest ask was the anticipated 10 per cent local share required of any future hospital redevelopment.
“In 2015 our estimates of this local share, including infrastructure costs and required equipment not funded by the MOHLTC (Ministry Of Health and Long-Term Care) ranged from $84 to $114 million, depending on the model we chose to go with. We do not anticipate that these figures will change substantially with the options being considered by today’s task force,” Board vice-chair Phil Matthews wrote in his speaking notes to committee.
Matthews has been on the hospital board for seven years, including in 2015 when the Board came out in support of a single hospital site to replace the existing two acute care hospitals in this region. That decision was met with vehement opposition from all community corners.
Fast forward to May 2017 and the hospital board has entered into a planning agreement with the Minister’s office which includes up to a million dollar grant to firm up its plan before trying to move it forward. You can find the agreement here. (The good stuff starts on page 26).
In terms of District support, council agreed to increase annual contribution to its health care fund from $400,000 to $600,000 with the entire amount expected to go to Muskoka Algonquin Healthcare (MAHC), which looks after both hospitals, sometime in 2019 once its other commitments have ended. But that’s a drop in the bucket compared to the numbers the hospital board was hoping for.
“There is no question that councillors at that level are prepared to make some kind of contribution off the tax bill towards a redevelopment and the capital needs of our hospital — there’s no question about that. I think the challenge that we have with their presentation was that we don’t have a plan yet,” said Huntsville Mayor Scott Aitchison, who chairs the District’s Corporate and Emergency Services Committee and also sits on the task force examining the various hospital models.
“I think the community has made it clear they don’t want something like a single site and yet the planning task force continues to contemplate that or other possibilities and I think until that’s completely off the table then they’re barking up the wrong tree,” said Aitchison, who indicated he would personally vote against any possibility of funding a single hospital site.
“Without some commitment from the District, nothing’s going to happen. So it tells me that they had better listen to what the community and what their council is telling them and that is that a single site — we don’t want that,” he added.
What do others on the task force have to say?
Doppler recently sat down with Cameron Renwick and Don Mitchell, chair and vice-chair of the task force.
They both pleaded for people to keep an open mind and assured that despite the hospital board’s 2015 recommendation for a single hospital site, all three models will be fully examined. They are:
- Two sites with emergency departments in each but services and programs consolidated between the two, such as the recent single siting of services like gynecological surgery and cataract surgery. Where each service ends up would be based on “clinical needs and service co-location requirements to create greater efficiencies, larger volumes and critical mass, and reducing duplication of staffing and equipment,” according to literature provided by Muskoka Algonquin Healthcare (MAHC), which manages both hospitals.
- One site inpatient/one site outpatient. These two facilities would also have emergency care departments but one site would maintain an outpatient focus, meaning no or very little beds, while the other would maintain most of the beds. “Outpatient services could include some day surgery, specialty diagnostics (such as MRI), clinics (such as dialysis), etc. Inpatient services could include medical/surgical care, intensive care and obstetrics.”
- One hospital to be ‘centrally’ located and provide all hospital services and programs on one newly built site. “Comprehensive work would be done to determine the role of potential vacated building(s) including the ability to support local urgent and primary care needs, community services, health hub development, or other alternative models. This exploration will include determining best ways to support access to urgent care models.”
Renwick was on the hospital board three years ago when it chose the one hospital model, but said a lot has since changed. “I was part of that decision in 2015 and I stand by what I did back then based on the information that we were given,” he said, adding that while three years may not seem very long “in health care time frame it is.”
He went on the record saying he has no preferred model at this point.
“I will go on the record to say I don’t have a preferred model, I will tell you that and that’s the honest truth. The important thing for me is that everybody has fair access, that it’s quality, that it’s sustainable, that we’re able to grow with our population,” said Renwick.
What’s different between then and now?
“I don’t think that we should be upset that that happened,” said Renwick, referring to the hospital board’s previous decision to go with a single hospital model. “We took a very quantitative approach but now we have certainly brought in a more qualitative (approach) by having a task force. I think what’s changed the most is back in 2015 when we talked about two hospitals for instance, there was no discussion as to what you do with two buildings or one building if they become redundant.”
Discussions around whether one or both of the buildings can be repurposed, whether they can house outpatient clinics or diabetes education or health hubs, those discussions were not on the table leading up to the Board’s 2015 decision and now they are, he said. “So that brings in a whole other layer of what could be.”
Renwick also cited other changes impacting the task force’s decision such as Patients First legislation which, among other things, looks to strengthen community care, enhance communication between the various providers, takes some services out of the hospital and into the community and follows the patient through the health care process from start to finish. Other changes include technological developments, as well as the need for flexibility in order to enable growth under any one hospital model.
The makeup of the task force has also changed. The group that previously looked at hospital planning did not comprise politicians, the work of MAHST (the Muskoka and Area Health System Transformation council) hadn’t occurred, there were no members with lived health care system experience and “I’d like to think I wasn’t on it before,” added Mitchell with a smile.
In terms of membership on the Board of Muskoka Algonquin Healthcare, since May 2015 seven of the 12-member Board have changed.
Why is the single hospital model still on the table?
Asked why the single hospital model is still on the table given community opposition, Renwick pointed to the Ministry. “The Ministry is the one ultimately that is the payer. I mean they are going to pay 90 per cent; the community has to bring in 10 per cent. If the Ministry said ‘look this is off the table,’ then that would certainly make our job easier but they have not and we’ve asked our LHIN (Local Health Integration Unit) is there anything that you do not want us to do and they’ve instructed us, ‘no, go through like the Ministry has asked and do a thorough and exhaustive review,’” explained Renwick.
He said he’s heard loud and clear that people want two hospitals — one in Huntsville and one in Bracebridge, and he understands that. “But what I heard overwhelmingly was they needed access to emergent care… and that’s completely reasonable. I think everyone around our task force table would agree with that. The question that I come up to though is about two fully functioning hospitals, all services in both hospitals, and that’s where we start to challenge not only having staff that can provide that care but a certain number of cases that can support the staff that want to provide that care. So that’s when we start to get into the nuance of two fully servicing hospitals and what they look like. That’s where the non-status quo really comes in,” said Renwick.
Is the hospital board influencing the task force’s final recommendation?
“From my perspective as a committee member, the relationship with the (hospital) Board is through the Board-appointed members on the committee… so the (Board) vice-chair (Phil Matthews) sits on the committee and I would certainly hope that the vice-chair and Cam, in his role, take back to the Board the discussion that is going on in the committee,” said Mitchell. “Any stuff that needs to come to the committee, the Board speaks to Cam, Cam brings it to the committee. So, there is a dialogue going back and forth but if you’re asking whether or not there’s influence going back and forth, I’d have to say that there hasn’t been anything that I’ve seen and I personally would find it offensive if there was.”
Renwick said he’s been told formally and informally by the Board that their expectation is that the task force thoroughly analyze all the options on the table and leave no stone unturned.
How much weight will the task force’s recommendation have with the Board?
“I hope a lot but again our mandate is to provide a recommendation to the Board of Directors so that’s what we’ll do. You’re right, I am a sitting Board Director so when the task force makes a recommendation we’ll be doing that as a whole and then I’ll step away from Board deliberations because that would be a conflict of interest,” explained Renwick. His only role at that point would be one of clarifying any questions the Board might have with respect to the task force’s presentation.
What about the economic spinoff associated with two acute care hospitals?
“What we’ve done, which is totally different from the last go around, is struck an economic development committee,” said Mitchell. He said the committee will meet for the first time in March, and assess the economic impact each hospital model being explored could have on the respective communities. “Definitely that will be a consideration in the task force going forward as well.”
What is the one major thing you’ve learned so far?
“I guess the biggest thing is what we don’t have. As a user there are certain services that I would’ve thought are here in Muskoka, which are not. That was the eye opener,” said Mitchell.
“The biggest thing I’ve learned is that this is a difficult process to go through… it’s not a simple task, I think,” said Renwick. “I’ll tell you something too — thinking people change their minds and we have a lot of thinking people around the table and that’s really an important piece because opinions are important but opinions can be emotional and when we bring in data and qualitative components to it, that’s the part when I was saying to you some doctors that you thought, geez they’re always going to (think) this way, and they now say ‘you know what, now that you mention it, I think you’re right, I think we could.’ Those are the kinds of shifts that we have around our table, now we just hope that we get them out into the public.”
And finally, what keeps you up at night?
“What keeps me up at night is when we have diverse opinions that slow us down because there is a queue and as much as we think Muskoka is this beautiful, fantastic place, which it is, there are other areas that are going through this as well that are moving quicker than we are and we have to move, we have to get going, because if we don’t get into a queue, we’re going to be slowed down. That’s my real concern, that we just get bogged down,” said Renwick, adding that he hopes the community is able to arrive at a consensus that everyone can get behind. “I don’t know how many times we can say it, but we have not made any decisions, there is no behind closed doors, that’s just not the case. I think sometimes it’s like trying to put toothpaste back in the tube, once people think that, pfft! I can tell you that I’ve got nothing in this other than the fact that I just want to make sure that we do a thorough job.”
Mitchell had a slightly different type of insomnia. “You know I’m an advocate for community-based health care and my concern is that community-based health care doesn’t keep the pace with everything that’s happening from the hospital perspective. I have a concern that the community doesn’t find community-based health care as important as what’s going on in the hospital… I am so afraid that community-based health care is going to be lost in the dust and when the time comes to launch the new facility, the programs and services that need to surround it aren’t going to be there. That’s what keeps me awake.”
Discussions and public forums continue. Check Doppler for future updates.
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