It’s been a long tumultuous journey, beginning in 2012, and now, finally, MAHC has abandoned their flawed 2015 single-site hospital decision. I have been outspoken on this matter, serving first on the MAHC board for two years (immediately following the original 2015 decision), and then for the last year as an advocate speaking out for the community’s wishes.
It is prudent now to reflect on what happened, with a focus on things learned, and, more importantly, what should change going forward so things don’t go off the rails again. The people won this battle, but the war for our hospital’s future continues.
Let’s recap
The original MAHC board decision to combine the two hospitals into a single site disregarded the voices of most of the community, medical practitioners/physicians, and political leaders at municipal, provincial and federal levels. It took over three years to correct, but not without significant ramifications:
Valuable time was lost—delaying us in getting into the provincial funding queue for much needed infrastructure improvements and upgrades;
Community uncertainty arose—negatively impacting hospital foundations and creating a drag on businesses and growth;
And there was a large financial cost involved.
So, what was learned and what should change?
Firstly, for the MAHC board. They didn’t listen to the community three years ago. Thankfully, they got the decision right this time, but were pushed there by the community, and it took far too long. Oddly, their most recent report (Stage 1A Decision Support report) highlighted two new key factors: 1) a Land-Use Planning report and 2) community support now viewed as critical. Neither of these factors should have been new. The District told MAHC in 2014 that a centrally located greenfield site was a non-starter from a land-use planning perspective (MAHC even acknowledged that position here) and previous thinking that community support was non-critical is hard to fathom.
Reportedly, this latest MAHC board decision was not unanimous, and it was made in a closed session. This is a concerning pattern as MAHC holds far too many critical board decisions out of public scrutiny. Further, the board is self-selecting, geographically imbalanced and unaccountable to the communities it serves, which leads to mistrust and mistakes. They need to acknowledge these flaws and move quickly to fix them.
Secondly, for the new Ontario government. Ontario’s hospital planning and funding processes and supporting bureaucracy is broken. Starting with community unaccountable hospital boards, running through ineffective and costly LHINs, and ending in a highly bureaucratic Ministry of Health & Long Term Care. Throughout all these layers are far too many highly priced consultants. MAHC just spent 6.5 years and multiple millions of dollars to arrive at a decision obvious to the community, yet we’re only part-way through the first of five planning stages. Hospital capital planning shouldn’t take decades to complete. The result is wasted tax dollars, long delays and community churn/disruption. Worse, we see continual service consolidations into larger urban centres, justified under dubious efficiency and cost-saving rationales. Politics far too often influences healthcare policy and funding decisions, mostly to the detriment of communities like ours.
Doug Ford won on streamlining government, accountability, respecting tax dollars and fairness. He now needs to follow through on his promises. What better place to begin than fixing the highly flawed hospital governance, capital planning and funding policies/practices? Over to our new Minister of Health, Christine Elliott!
Lastly, for the community. If not for a small core of outspoken and committed activists, medical practitioners and a few engaged political leaders, this two-site decision would not have happened. Their sustained efforts educated, energized, and mobilized the community. So, democracy worked, and the people scored a major win. Still, much remains to be done.
Next steps
The next step (Stage 1B) is where site designs, locations and costs are defined. The high cost arising from the total “new build approach” remains concerning. Once again, this approach drove costs into the $500 million range (with a local share in the $140M range). As I and others have pointed out previously, it’s unnecessary, unreasonable and unaffordable given our community statistics and hospital ages. It’s also out-of-line with other comparable hospital projects. Neither the provincial nor municipal governments are likely to approve such a large ask. If this thinking by MAHC and their advisors continues, the planning process will once again be unnecessarily bogged down.
The community must stay vigilant and engaged. Many of the same MAHC, LHIN & Ministry players who have been deaf or indifferent to the voice of the people remain in place. We now have the long overdue change at the provincial level. Although we had support from some of the mayors (Huntsville Mayor Scott Aitchison, in particular, for his unwavering support) too many locally elected officials were reluctant to speak out while the community rose up. Let’s hold them to account in the upcoming fall municipal elections.
Dave Wilkin is a (former) MAHC board director, retired banking & IT executive and a Community Advocates for Hospitals and Healthcare for Muskoka and Area (CAHHMA) member. For more information and to join, visit http://cahhma.com
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Mr. Wilkin: if the Board is not accountable to its community, then to whom is it accountable? That it is self-selecting is a given: It’s always the Nominating Committee’s mandate to choose worthy candidates for an election by the Board. It should be geographically distributed in some manner (“rep. by pop”, medical professional/layperson, aboriginal representation if numbers warrant, etc.).
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But unless a board has one employer; in this case, the community; and one employee (the CEO); then it cannot and will not function. Also, in general, the less directors, the less unwieldy it is to arrive at a consensus.
Rob, the issue is the board has no official accountability to the community it serves, which is not good. Only the the MOH can dismiss it & appoint a supervisor, which is very rare. We almost reached that point, with Huntsville town council voting non-confidence back a few months ago, which would have put a lot of pressure on the provincial government to act, had things not improved.
It should be noted, our hospital board is certainly not unique is this regard. Others have faced community blow-back to decisions deemed unacceptable (recent example, Welland). My point is the new MOH needs to look at how boards are constituted & governed, and make changes so they aren’t just a just a passthru for the LHIN/MOH bureaucrats who over-see them, or pushing their own agendas, but a strong voice for the community they serve.
Regarding board make up, in public for-profit corporations, the shareholders have to approve board appointments. Hospital boards have members, no shareholders, and in MAHC’s situations, as designated in their bylaws, the board members constitutes the members of the corp, and therefore, they appoint all future directors. The issue here is no accountability to the community, and If you get a dysfunctional board, in the eyes of the community, its very hard to get change.
Regarding board representation, the issue here is that the current board is heavily skewed geographically to the southern end of the catchment area. As I understand it, only 2 of 12 directors currently come from north of the P. Sydney area, and there are none north of Huntsville. This normally might normally not be a big deal, but when it comes down to decisions of how funding is spread between the 2-sites, or, as the case when there was only going to be 1 site in a TBD location (pre-capital stage recommendation to single site), its potentially a much bigger issue. It certainly sets up for the possibility of bias, and almost certainly some community mis-trust of any decision made. This is not good.
For a great description of these and other MAHC governance related issues, please see Sven Miglin’s great Doppler article from April:https://doppleronline.ca/huntsville/mahc-is-a-self-appointing-board-sven-miglin/