To the Editor,
Health Care expenditures support a system that Canadians and Ontarians greatly treasure. For Ontarians that’s about $61.2 billion, up sharply from $55.9 billion in 2016-17.
Hospital mega-projects seriously threaten this system. At least five mega-hospital projects totalling $9 billion dollars in capital are being planned and built in Ontario as we speak. And once the ribbon is cut, the costs really go up – that $9 billion is then spent every year to operate. Once built, if a hospital is over-sized, we’re stuck with it for decades. If these hospitals mirror the hospitals in Ottawa, they are expanding inappropriately, at tremendous cost, inefficiencies and all.
Oh, the inefficiencies! We always seem to need more hospital beds, hospitals and emergency wards that are being chronically overburdened with patients and always in crisis. However, several of the causes for overcrowding lie outside of the hospital. For example, many patients don’t belong in a hospital, but have nowhere else to go. Ten per cent of health costs occur in the last year of life because palliative care and patients end up in hospital inappropriately. Stroke commonly causes admission, yet 50 per cent of hypertensive patients (hypertension = the leading cause of stroke) neglect their medication. Community care home services (formerly CCAC) have underperformed for years. The LHINs are ineffective and costly, according to the auditor general. Effective programs like community paramedicine have not been expanded in a meaningful way. Emergency wards have long wait times, yet many patients are not emergencies. Too many family physicians don’t see patients in a timely fashion.
The Ottawa Civic Hospital, plagued by the sort of systemic inefficiencies mentioned above, proposes doubling in size, at a cost of $2 billion to build, and then, to operate annually. To provide perspective, the entire Champlain LHIN annual budget, which includes hospitals, is “only” about $2.5 billion.
If the bathtub is overflowing, do you get a bigger tub, or do you shut off the tap?
I propose the Ministry of Health and Long-Term Care provide leadership and not allow hospitals to essentially plan themselves. Hospitals are a health destination of last resort. Hospital mega-projects drain resources for a hundred kilometers around and decades in the future. The Ottawa Civic Hospital expansion planning is taking place in relative isolation and is based on brute force – getting the bigger bath tub – rather than including the rest of the health care system that could “shut off the tap.”
Hospitals like the Ottawa Civic, with important research and advanced-care mandates, should give up their emergency wards and secondary level care – they don’t manage them well. The Ottawa Heart Institute is a world-class example of this concept, focussing on its advanced mandates from non-invasive coronary to heart transplant surgery without exposing its vulnerable population to infections and capacity demands from an emergency ward. Funds would then be available for the development of more basic, community-tuned hospitals in areas of need.
The Ottawa Civic Hospital expansion as planned, represents a financially, clinically and politically risky blunder. It’s an irresponsible, unaffordable, and ineffective substitute for thoughtful, whole-system reform.
Let’s shut off the tap, open the drain and clean up the whole system before even thinking of expanding a hospital.
Dr. Barry Bruce
Dr. Bruce is a family physician in Eastern Ontario, part of an award-winning Family Health Team. He has served as Chief of Staff in a secondary level urban hospital, was the Primary Care Lead for a sub-LHIN from 2013 to 2017 and has received the OMA Physicians Care Award, Family Physician of the Year for Ontario, and the Order of Ottawa.