By Dave Wilkin and Ross Maund
This is the second article in our Big Challenges series. In this article the focus is on a better pathway forward for our hospitals’ future redevelopment.
First, a few pieces of important background:
1. A hospital’s redevelopment capital plan should align with future health care priorities (reference our 1st article).
2. Hospital complete replacements will be even rarer – confined to the oldest hospitals. The average age of Ontario’s 234 hospital sites is 47 years (the same as MAHC’s two hospital average age).
3. New hospital builds are prioritized to areas with the largest demand, mostly in high population growth areas of the province.
4. Reaching the latest provincial hospital standards occurs in an evolutionary manner.
5. The Health Ministry currently does not place a hard cap on major hospital capital requests. They do however require the benefitting communities to demonstrate economic support capability for their ‘local share’ of the project.
6. The local share is paid for by municipal and district new tax levies and debt financing and additional hospital foundation donations. Unfortunately, this burden falls heaviest on rural/smaller communities like ours, which typically have a smaller business base, less household income and slower growth than large urban centers. This has been well documented.
7. Community equity and fairness is a goal (of most governments).
MAHC’s planning and decision-making processes appear to have overlooked or ignored most of these things. It likely leads to their recommendation for two new build hospitals being rejected.
An aligned and more realistic approach would lead to a different plan recommendation, like this:
1. Both full-service acute care hospitals remain in place on existing sites and are upgraded, avoiding significant site acquisition, servicing and demolition costs.
2. Accelerated approval based on phased development delivering upgrades sooner.
3. Evolution to Ministry of Health hospital current/future standards, with plans allowing for adjustments and expansion of new patient service demands and expected new delivery approaches.
4. Existing hospitals’ expansion aligns with future hospital services directions (day clinics, outpatient day services, community wellness etc.).
5. Renovation plans include reconfiguration and optimization of existing spaces (including currently unused/poorly utilized space) and address the longstanding facility and equipment deficits.
6. Increased emphasis on newer technologies & equipment that improves patient outcomes and productivity, not compromised by local share cost reduction maneuvers.
7. This redevelopment cost capped at an amount deemed affordable and fair to the Province, District and local municipalities. We anticipate that to fall in the $275M to $350M range (2019 $), cutting the local share cost burden roughly in half.
The benefits of this approach are clear:
· Aligned to the future direction of health care investment priorities
· More affordable/fair to all levels of government
· Allows for more funds to be made available to invest in other high priority community health care & wellness areas
· Far more likely to be approved, leading to earlier delivery of long overdue improvements
· Better positioned to negotiate a local share reduction from the Health Ministry
· More adaptable to future service demands and technology changes we know are coming
· Significantly reduced risks of over-building and future operating budget deficit growth
Whether it is receiving timely provincial approval or getting to an affordable local share, this is not what MAHC’s plan does. Everyone would love to have a large brand-new hospital nearby, but we can’t have it all. After eight long years of capital planning, it’s past the time to get on a realistic path to deliver meaningful results to our community sooner.
Our next article in our Big Challenges series explores the major destabilizing shifts in population, demographics and growing economic inequity. Watch for it!
Dave Wilkin, P. Eng, M.Eng.
Ross Maund, career senior executive
Both are Huntsville residents, and former MAHC board directors.
Don’t miss out on Doppler!
Sign up here to receive our email digest with links to our most recent stories.
Local news in your inbox three times per week!
wendy j brown says
Very interesting and informative story thank you gentlemen.
Rob Millman says
Thank you for presenting a realistic option. Too many people have been drinking the Kool Aid for too long: We were NEVER going to get two brand spanking new hospitals. I feel that Bracebridge, perhaps, skewed the proposal by dreaming about their new site; and Huntsville followed suit.
Not to my great credit, I have always been on board with your alternative proposal. It simply makes good sense fiscally, and ensures the best healthcare for our tax dollar. The fact that it is potentially acceptable to the province is obviously its major appeal.
Bob Slater says
FOLKS .. I just had a friend who had a heart attack .. went to Huntsville and was immediately transferred to NewMarket ..South Lake! .. We need a study done by the “MAHC’s planning and decision-making” team to document ALL services that require citizens of Muskoka to be shipped south to Orilla, RVH or South Lake .. and ..added to that study … what NEW services we citizens will get delivered via the current MAHC’s plan that will stop this ‘shipping’ service provided by the current 2 hospital situation? If the results of such study has a financial ($$$) slant that is the reason ‘why’ we will continue to ‘not’ get these NEW ‘down south services’ than we have accomplished nothing! AND .. we need to stop and evaluate the 2 hospital plan … make the hard …non-emotion … non-political based decisions .. and ..face the reality of the current plan accomplishing … nothing!
Ray Vowels says
My Opinion for what it’s worth and likely that is not too much. My way of thinking is what we need most is more doctors in the E.R. during busy times summer and winter holidays. Anyone that has had to go to the E.R. is aware of just how long it takes to get to see a doctor and that is not because they don’t care it’s simply they have too many people that they are trying to look after. Nurses are in the same boat then there is the ton of paper work that has to be done. It’s just too much for the staff that’s on duty most of the time. I have been there quite a few times both for myself and with my wife and have always been treated first class and as quick as they could get to us. And if it’s necessary sending patients to south lake is the very best option they have the very best doctors and support staff so unless we were to somehow afford the specialists and equipment the best option is still to get a patient to a bigger center.
Dave Wilkin says
I agree Ray. We also need an expanded and upgraded ER.. it’s long over due.