It’s irrational: the Ontario Ministry of Health and Long-Term Care encourages communities to engage in suburban sprawl with policies that effectively require new hospitals be located on the very edge of the communities, or beyond.
It is occurring so frequently that it appears to be ministry policy: don’t build a new hospital in the centre of town, only on the periphery. That's what has happened in Owen Sound, St. Catharines, North Bay, Oakville, Peterborough, Barrie, Cobourg, and other communities.
And there are plans to do the same thing in Windsor, where the two large downtown hospitals are slated to be torn down and a new $2-billion facility built out beyond the city’s airport; in Collingwood, where the downtown hospital would be demolished and a new $400-million facility built among farmers’ fields, beyond what town council calls its “built boundary;” and in Bracebridge and Huntsville, where two hospitals would be demolished and a new one built literally halfway between the communities, in the bush.
In each case the local hospital board recommends the site, so the ministry can say it is simply responding to a local request. But ministry staff has also told boards they must find a large site, at least 30 acres in size, in order to create a health campus for the next 50 or 100 years. Local boards often hire, on the advice of the ministry, large international consultants to advise them, and these consultants specialize not in understanding local conditions but in recommending large new flashy facilities whatever the cost.
According to numerous councillors in these Ontario cities, as well as hospital board members, ministry staff tell local boards if a community objects to a proposed new facility, its application for a new hospital — and for the requisite funding to accompany it — will go to the end of the line. Local leaders often collapse in the face of this pressure and agree to build far from community centres.
Provincial planning policy, as set out under the Planning Act, discourages sprawl and encourages intensification, with many sections stressing the need to locate services close to population centres to conserve energy and use existing transit services. The ministry seems to think it is above these concerns, and so far, few councils and hospital boards have been willing to enforce these policies, probably because local officials are worried the province will cut off funding for new health care facilities if they do.
Locations on the edge inconvenience most patients. In Collingwood, for example, retirement homes, the hospice, and doctor’s offices are all located close to the existing hospital but won’t be close to the new facility. Most patients and their families live in town, not in the fields surrounding the new facility, and there will be little public transit to the new site, so it will be more difficult (and more costly) for those who will need to rely on taxis to get there.
The edge location forces local property taxpayers to pay the added servicing costs associated with extending basic infrastructure (power lines, sewage, and so forth), as well as the cost of tearing down the old facility. The local community is weakened economically, as the many people who worked at the city-centre hospitals are now located on the far outskirts.
This is not patient-centred care, the ministry’s stated goal.
It undermines rather than improves existing services. The only rationale one can think of for choosing these edge locations is that they offer sizable pieces of land where some large company, retained under the Public Private Partnership (PPP) model used by the Ontario government, can have a free hand in construction. (It is not impossible for a PPP to build a hospital on a smaller site in town, but the logistics of constructing a complicated facility are easier to manage on larger parcels of land without the constraints of existing infrastructure, like roadways and electric lines.) Under PPPs, the government-hired company designs, builds, and then operates these facilities, often at greater expense because of their size and location, but the ministry needs to pay no money until the place is open and operating — seven or eight years from now, well after the next election.
So PPPs are really attractive to governments, just as automobile companies have found it makes sense to tell people they can buy now and not pay a cent for a year or two, sometimes even offering instant cash back for signing the deal today. But PPPs are expensive — according to one Ontario auditor general's report, about 18 per cent more expensive than if the government built the hospital itself. For a $400-million proposal like the one in Collingwood, that’s a $75 million difference.
The Collingwood General and Marine Hospital already owns enough land around the existing hospital that new clinical facilities could be built on site, and existing buildings renovated for hospital office use. It’s an alternative that is a lot cheaper and inconveniences no one.
But the hospital board and the ministry are not interested. They have their sights set on the edge of town in Collingwood, in Windsor, and everywhere else. Sadly, they are being shortsighted.
John Sewell is a former mayor of Toronto and a weekend resident of the Collingwood area. Karina Dahlin is a writer living in Collingwood. Both are members of Citizens for Collingwood Hospital Development, which has created plans showing how the new facility can be built on the existing hospital site.
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