Why can’t Ontario follow its own rules on hospitals?

OPINION: Provincial policies state that new infrastructure shouldn’t drive sprawl. But those policies go out the window when it comes to building hospitals
By John Michael McGrath - Published on May 09, 2017
Despite what Queen’s Park says, hospitals in urban areas can be rebuilt — as Women’s College Hospital has proved. (Fred Lum/Globe and Mail)

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Another budget cycle, another example of the Liberal government throwing its cherished planning rules out the window when it comes to hospitals. In the 2017 budget plan announced last month, Premier Kathleen Wynne committed the province to building a new facility in Niagara Falls, part of the government’s $9 billion increase in hospital funding.

There’s no particular reason to begrudge the Niagara Region a new hospital — Ontario is aging all over, and there’s good reason to think we’ll need more medical facilities as baby boomers approach the age when people need health care most. The problem isn’t with the purpose of the building — it’s with its probable street address.

Niagara Falls wants to build its new hospital on 50 acres of greenfield land south of the city. Nearby St. Catharines did the same thing with a greenfield site that opened in 2013 — and the hospital there has, predictably, dragged sprawl toward it. There’s no reason to think the one proposed for Niagara Falls won’t do the same.

Officially, no one’s made a final decision on the Niagara Falls hospital (or the one in Windsor, also approved in this year’s budget, also on a greenfield site). But Niagara Health has the land set aside for the building in this one and only spot, so it’s not as if there’s an embarrassment of options on the table.

This is, of course, contrary to the province’s own policies: the Growth Plan for the Greater Golden Horseshoe, which applies in Niagara Region, says “community infrastructure” — explicitly including hospitals — should be built to support intensification and not sprawl. Hospitals, having a price tag of around $1 billion, most definitely count as “community infrastructure.”

(The Liberals, in fairness, also announced funding for two new hospital projects on existing sites, as well as one in partnership with the federal government that will serve the First Nations of James Bay. But it’s hard to applaud them when they follow their own planning rules only half the time.)


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The Liberal government says it needs to work with local partners — meaning municipalities and health agencies — when siting hospitals. But it’s provincial policies that are driving these decisions, not just local officials. That’s why this keeps happening in far-flung parts of the province, from Ottawa to Windsor to Collingwood to, yes, Niagara.

The Ministry of Health and Long-term Care wants sites that can be rebuilt easily at the end of a hospital’s operational lifetime. That means modest structures amid oceanic parking lots (which, incidentally, need to be bigger now that the Liberals have restricted how hospitals can charge for parking.) When the current hospital needs to be rebuilt 50 years from now, presto, erect a new one on former parking lot.

There’s nothing wrong with the government thinking ahead — indeed, it’s something we should encourage. But thinking ahead was ostensibly the motivation behind the Growth Plan, too, and the current state of affairs demonstrates just how bad the Liberals are at reconciling competing priorities.

Taken to their logical ends, the government’s hospital-siting policies lead to some pretty strange places. Not one hospital in downtown Toronto has the kind of massive, easily developed parking lots the government says is necessary for a proper hospital — including some of the best medical facilities in the country. Should the Hospital for Sick Children be demolished to provide parking for Mount Sinai, or vice versa?

It is, in fact, possible to build and rebuild hospitals in built-up areas. Women’s College Hospital, also in downtown Toronto, completed their rebuild a few hundred metres from Queen’s Park in 2016. Only slightly farther away, SickKids wants to do the same in the coming decade.

No doubt these things are harder to do in urban areas, and the greater the difficulty, the greater the expense. But this isn’t new or unexpected; it’s precisely what the government had to anticipate when it formulated the Growth Plan in the first place. Intensification is and always will be harder and costlier than building in greenfields, whether we’re talking about hospitals or homes.

And this is the crux of the matter: the government isn’t required to follow the rules it sets for, say, developers. So half the time it doesn’t, because to do so would be difficult, expensive, and potentially an unnecessary use of taxpayer money.

But the government also claims its Growth Plan is not and cannot be responsible for the increasing cost of housing in the Greater Golden Horseshoe. If we’re to believe the Liberals, their signature land-use policy drives up the cost of hospitals but, magically, not housing.

There’s an alternative explanation: the Liberals are right about the Growth Plan and right that it doesn’t drive up construction costs for hospitals or housing. They simply don’t mind that the Ministry of Health is carving up farmland and encouraging sprawl for no good reason.

Neither explanation is particularly reassuring.

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