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.
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