We believe MAHC’s plan for two new hospitals will be rejected by the Province



By Dave Wilkin and Ross Maund
MAHC’s Two New Hospital Plan – The Big Picture

MAHC’s recently published Stage 1B Capital Plan submission calling for two brand new hospitals is a significant milestone in a journey that began almost eight years ago. However, as we have written previously, we have concerns with this plan, mostly around its affordability. Nine comparable hospital projects show MAHC’s plan is triple the average cost-per-capita.

In terms of the local share portion of the total cost, it is being rationalized down and minimized. This is particularly troubling, given the cost escalations in new equipment, technology and construction. MAHC’s very experienced consulting firm, Hanscomb, on page nine of their report to MAHC, estimates our local share at $180 million of their estimated $705 million total cost (both in 2024 escalated $ costs, when construction may begin). Using this $180 million number, less $20 million from additional foundation commitments, translates to about $3,200 on average per household for the roughly 50,000 served dwellings. We hope municipal governments calculate the most likely cost of this plan for their taxpayers. Affordability (locally and provincially) explains why most hospitals (particularly of our vintage) are incrementally upgraded/expanded, not replaced.

We now turn to a bigger picture.  Locally, such a massive capital project will crowd out investments in other high-priority needs, including affordable housing, Long-Term-Care (LTC), attracting new businesses, and addressing energy transition/climate change (Note – doubling of the existing hospitals’ size is not helpful to this cause).

Provincially, Minister of Health Christine Elliott is hard at work reforming Ontario’s health care system. Parts of her plan are already underway or evident, with more to come. We see an over-arching theme to bend the escalating healthcare cost curve down, without compromising quality/service levels. Clearly cost growth can’t continue at its historic pace, but instead the system faces growing structural headwinds which will accelerate it: an aging demographic, increasing longevity, and technology/construction/labor cost escalation. Healthcare spending in Ontario today is 42 per cent of all government program spending, with a forecasted growth rate over double the core inflation rate.

To that end, we anticipate the following shaping the provincial health system:

  • A short-term focus on quickly opening new beds to address ‘hallway health care’.
  • Reduced demand for beds by: getting people out of hospitals faster and being placed into lower cost facilities and/or home. Keeping people out of hospitals with an increased focus on prevention. This implies increased investment in local health teams, alternate levels of care, LTC, mental health and new technology.
  • Clear new standards on hospital capital funding (including caps), construction standards, and clear guidelines on hospital closures and replacements. Size/cost control, equity, and accelerated decision making/results are all likely objectives.
  • Standardized and aggregated purchasing of medical equipment, IT and perhaps drugs.
  • A significantly trimmed down bureaucracy, and a more direct role for municipal governments in hospital governance and capital planning.

Slowing, and ultimately reversing the escalating of hospital sizes/costs is a core goal. MAHC’s plan for two new hospitals, more than doubling the size, is out of sync with this direction.

We believe this plan will eventually be rejected by the Province, lacking affordability, equity, and future direction alignment. This leads to yet more delays in getting long overdue hospital upgrades and prudent expansion.

We are simply stating important relevant facts and the clear direction before us. We are not fear mongering or being divisive, as some have suggested. Our communities are facing the single largest capital investment in history, on a service that is vitally important. We need more open and transparent discussion, based on facts, so the people can be fully aware and onboard. We can’t afford to get this wrong.

Ross Maund and Dave Wilkin are business executives and former MAHC board directors.

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  1. The Only problem I see with the current hospital is the E.R in summer it could be bigger with more staff maybe more staff is what’s needed more than a new hospital. A little paint and minor fixing would do wonders for what we have.

  2. Many good points made here. Go to almost any hospital in Ontario and you’ll see an old building with a new expansion, still offering excellent care. I can appreciate the hundreds of hours spent on consultations, committees, projections, etc, often by volunteers. As I said here about 2 years ago, some upper level Ministry of Health civil servant, who has never been North of Highway 7, will make the ultimate decisions. We won’t be totally happy, but to expect TWO new hospital builds is unrealistic.

  3. Methinks it is better to ask for it, and be turned down, or receive a counter proposal, than not to ask for it. In the latter case, you will never get anything, at all, ever.

  4. Bill, here is the problem, again, with asking for something this far out of line with the current fiscal reality – more valuable time is lost. In this case it could easily add several more years after being sent back to redo the submission. MAHC has not constructed/presented a lower cost/affordable renovation/expansion plan for consideration, to our knowledge. They seem fixated on a distant future, 15, 20, even 50 years down the road in their commentary and references. All the while immediate demands grow and the backlog of infrastructure upgrades in the queue builds. The Huntsville hospital hasn’t had a major upgrade since it opened over 40 years ago, according to MAHC. We are coming up to 8 years into this capital plan cycle, and remain in Stage 1 of 5. We should expect better.

    Also, please explain how submitting a more reasonable/staged plan translates into “never get anything, at all, ever” ? It’s not at all clear.

    • Sir, I cannot ascertain whether you were part of the 8 year study already passed, or not…but you seem to be suggesting another eight years.,.,
      Your message indicates that you disagree with the current plan…which will undoubtedly lead us into another long time frame of study. planning and review..by which time escalation will have added even yet to the projected costs.
      Perhaps you are a consultant…if that is the case, I understand your concerns…because your livelihood and income will be jeopardized by the end of this consultancy.
      I was merely pointing out a stance against the theme of your message…
      If you do not ask at some point, there will never be a resolution…only continued discussion, debate, planning, and meetings. Stop second guessing. Let’s make the ask, and then we can follow a known script.

      As the saying goes in the Maritimes..,,. “Are you going to fish, or cut bait?”

  5. Who really knows what will happen 15-20 years down the road.
    What about now!! As Ray points out we could improve on the emergency department all year not just the summer months. More space, more staff. I know they don’t have the funding.
    If you require a specialist or follow up care “Toronto is only a 2 hour drive down the highway.”
    I have taken this 2 hour drive many times and it is usually a 10-12 hour day. At least 8 hours return
    if you can get to Toronto. What is being done about this kind of problem especially for our seniors and women with children?
    What more can be done NOW rather than 20 years down the road. Time will take care of itself!

  6. Thank you, sirs: Perhaps, the more times people hear a REALISTIC message; the more chance it will have of eventually taking root. You are certainly preaching to the choir of one particularly vocal Councillor, myself, and a handful of other locals who have attended all the meetings, and perceived the flaws in this potential submission. And I totally agree with Mr. Wilkin. If this becomes our submission, when it is inevitably rejected, the Ministry is not going to magically award us Plan B.

    As you suggest, we need to submit a well considered, staged-construction approach to the expansion of both hospitals. And this doesn’t entail a complete return to the drawing board; as the renovation/expansion of both hospitals was already considered and costed as a comparator (with respect, wildly inaccurately IMHO). Furthermore, each hospital must specialize in several areas (ideally to the level of centre of excellence). This should limit the required expansion of each facility, and significantly reduce the cost of highly technological equipment.

    A bit of paint here and there would be like putting lipstick on a pig. And I don’t mean to denigrate the level of healthcare available at Huntsville Hospital (which is excellent). I only mean to stress, in the strongest possible terms, that MAJOR changes are required NOW to ensure that our offspring and their offspring are guaranteed that same excellent healthcare in the future.

    This is our one kick at the can for the foreseeable future: Let’s not waste it by being grandiosely greedy.

  7. Bill, I was on the MAHC board, as I noted, and an advocate and strong voice for listening to the people/community, always. The people clearly stated they wanted to retain a hospital in each town. Sure, it would be great if each town could get a brand new hospital, but given all we know now, especially the cost, it is just too expensive, and not required. Upgrading and expansion will work. It’s what most other community hospitals of our vintage do. I believe most people will understand this.

    Lastly, you seem to be suggesting that I am profiting some how from this as a consultant. I am a P. Eng, and have a Masters in Electrical Engineering. I have consulted extensively in my 40+ year career, mostly in IT. I have worked for large companies, including IBM and Scotiabank, as well as small ones. As a career professional, ethics has always been top of mind. Honestly, I find such speculation of a massive undeclared conflict in interest not only absurd, but offensive. No, I am not a consultant profiting from this initiative. I am a concerned citizen, living in Muskoka.

    • Hi Dave, I have been trying to understand what the problem is with Huntsville’s hospital. It still seems new to me I believe it was designed to go up another floor if needed .Other smaller renovations would surely be less expensive than a new build. We don’t need a huge atrium or other frills to deliver top quality healthcare. Thanks Rick

      • Yes Rick, you are bang on. There is no barrier to expanding the Huntsville hospital. Expanding the Bracebridge hospital requires a bit more thought, and creativity to keep costs down, but it its also very doable.
        MAHC’s own engineering firm, Hanscomb, has plans showing how it can be done. They need to be scaled back, and staged out, as demand and standards evolve. As I have pointed out previously, there is no government mandate or policy that says all hospitals have to be rebuilt to today’s latest and greatest new standards, by any date.

  8. One thing I have noticed when visiting relatives in Huntsville Hospital, the West wing I believe
    it is called, on the second floor has fully equipped rooms that are being used for storage and offices??
    I can only wonder why?? Perhaps funding is not available for staff and ??
    Then we complain about hallway medicine in the emergency department.
    Maybe opening up more rooms in the west wing would be a NOW answer
    to many problems rather than waiting 15-20 years in the future.

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