1. Prince Edward County Memorial Hospital New Hospital Planning
Brad Harrington, Vice President & CFO
November 18, 2016

2. Existing Hospital\New Hospital!.
A detailed technical evaluation of the existing PEC Hospital building was completed in This evaluated the functionality of the space, and also the current condition and suitability of all primary architectural, mechanical and electrical components. The Architect’s summary concludes:
“PECMH, now over 50 years old, lacks the flexibility, services and space standards and Infection Prevention and Control measures fundamental to current standards of care. Through an evaluation of the existing building both functionally and technically, the hospital structure is at the end of its lifespan. Room sizes, floor heights and corridor configurations limit any potential for renovation to improved standards.”
The existing Prince Edward County Memorial Hospital was constructed in 1959, to provide hospital services for the residents of Prince Edward County. The original hospital supported a service model which included:
24/7 Emergency Department
64 in-patient beds, including Maternity
4 Operating Rooms for general surgery.
Ambulatory and support services including; physiotherapy and a lab.
The current Hospital, housed in the same facilities, supports a service model which includes:
24/7 Emergency Department, including point of care lab.
14 in-patient beds, Medical and Complex Continuing Care
1 procedure room for endoscopy (ambulatory)
The July 2006 Ministry of Health/LTC provided a planning grant for redevelopment of the facility, aligned to current and future service requirements.

3. How do we get approval for a New Hospital?
5 Stages:
Approvals at each stage are by MOHLTC (HCIB)/SELHIN and are considered in respect to:
Alignment to MOHLTC/SELHIN guiding principles and priorities.
Consistency with community needs and service need projections.

4. What is the MoHLTC Capital Priorities?
MoHLTC evaluates capital projects with primary consideration to the proposals alignment to health care system and regional priorities. Within this context, the proposal must also demonstrate:
Operational efficiency
Accessibility
Safety
Infection Prevention
Sustainability

5. MOHLTC – RURAL AND NORTHERN HEALTH CARE FRAMEWORK
In 2010, the MOHLTC developed guiding principles for rural health care planning:
Community Engagement
Flexible Local Planning and Delivery
Culturally and Linguistically Responsive
Value-Overall efficiency and cost effectiveness of regionalized care
Integration with community
Innovation
Connected and coordinated with LHIN, provincial initiatives and organizations
Evidence-based; Sustainable – maintain and improve access

6. What are our SE LHIN Priorities?
Three Key Priorities:
Developing a regional system of integrated health care across the care continuum, from primary care and public health through to community, acute and long-term care
Improving the patient experience with a focus on the transition points in care
Focusing on the unique health care needs of Aboriginal and Francophone populations

7. Community Engagement My local health care system should provide:
1. Family care providers who:
Provide system navigation and equitable access to services
Help keep people healthy through health promotion and maintenance
2. Local access to:
24 hour emergency services
Inpatient beds
Basic diagnostic services
Home and community care services
A sustainable, local system of care that can create healthy communities and is:
Patient-centered
High quality
Timely
3. Efficient access to specialist services
With adequate transportation options
4. Effective coordination of services and communication between providers
QHC, the LHIN and our health care partners are undertaking intensive community engagement process from April to September 2015, designed to inform long-term decision making for a sustainable health care system in this region.
Purpose:
Help inform decision-making for the future of health care services:
QHC distribution of clinical services in 2020
Supports and gaps that could be met by other partners
Health Care Tomorrow: Hospital Services
PECMH redevelopment
Provide outlets for the community to voice their concerns and ask questions before decisions are made.

8. How do we get a hospital approved? Key Terms:
What is a Pre-Capital Submission?
The Pre-Capital submission is essentially a 15-page template that poses a number of questions we answer to paint a picture of PECM role as a health care provider in the local health system.
What is a Master Program?
A Master Program outlines the type and extent of health care services that QHC intends to deliver.  In other words, the Master Program reflects a health care facility's present and future service role within the community.  It outlines current and projected future programs and services, workload, staffing and departmental space requirements by site.
What is a Functional Program?
A functional program, typically developed by a functional programmer consultant, is a pre-design document describing the functional requirements of a building or renovation in sufficient detail to initiate schematic design.

9. QHC Hospital System – Master Program
Primary Care Hospitals
Regional Secondary Hospital
QHC Belleville General Hospital
QHC Prince Edward County Memorial Hospital
QHC North Hastings Hospital
Core Primary Care Services:
Emergency Room (24 hour)
Acute Inpatient beds
Appropriate basic diagnostics and clinics
Regional Services:
Obstetrics/Pediatrics
ICU
Surgery
Internal Medicine
Oncology Clinic
Mental Health – inpatient/outpatient
Inpatient Rehab and Rehab Day
Children’s Treatment Centre
Supported by advanced diagnostics:
- MRI CT
- Cardiopulmonary Bone mineral density
- Nuclear medicine Lab
- Interventional radiology
QHC Trenton Memorial Hospital
Each with “Protected” Core Services:
Emergency Room (24 hour)
Acute Inpatient beds
Supported by:
Appropriate basic diagnostics for ER and inpatients
Ambulatory clinics appropriate for hospital-based delivery and based on local need
In response, the QHC Board and leadership team are committing to the future of all four hospitals, each with a 24 hour ER, inpatient beds and basic diagnostics. All of our hospitals will remain open, and with 24 hour emergency rooms.
However, under the new funding formula, QHC cannot continue to split secondary level services between two hospitals. Instead, we must support three strong, primary care hospitals that each offer 24-hour emergency care, the required number of inpatient beds for family-physician level of care, basic diagnostics and appropriate hospital-based clinics. Almost all secondary level services would then be consolidated at BGH in order to deliver them in a cost-efficient and high quality manner, particularly given our relatively small and decreasing volumes in this region.

10. QHC Prince Edward County Memorial Hospital: Today & Tomorrow
Low risk regional endoscopy services
Emergency room (24 hour)
Acute inpatient beds
- General, acute care for elderly
Basic diagnostics:
- X-ray, ultrasound
- Point-of-care lab
Ambulatory clinics (e.g., mental health services)
Similarly, PECMH services remain larger the same, but there will be adjustments required to provide these services within the provincial benchmarks.
Can continue to efficiently provide endoscopy services at PECMH as long as volumes remain consistent with what we have been doing.
Efficient access to BGH specialist services

11. Presentation Title Presenter’s Name and Title Date of Presentation

12. Where are we with the Approval?
2013: Agreement of PECM and PEFHT to proceed with co-located physical facility model, i.e., hospital and FHT on same site but in separate buildings
Precap Submitted (January 2015)
Stage 1 Part A Completed (May 2016)
Corporate Master Program Submitted (October 2016)
Waiting on MOHLTC approval of the Pre-Capital submission before proceeding to complete the Stage 1 Part B (Master Plan)
MoHLTC approved a Planning Grant in July 2006
Master Programming review started July 2006.
Draft of Master Programming for the new hospital completed September 2008.
On-going work delayed due to QHC restructuring 2008/09
Joint Planning with Family Health Team initiated May 2010 (Full Integration Model).
Stage 1 Report completed November 2012
Hospital Planning restarted April 2014 (FHT Co-location Model).
Pre-Capital Submission to MoH/LTC January 2015
Pre-Capital approved by the LHIN December 2014
MoH/LTC approval pending

13. Is this a Priority for QHC?
The Corporate Master Program/ and Pre-Capital submissions identify redevelopment of PECM as the #1 QHC redevelopment priority.
Services will include:
24/7 Emergency Department
Diagnostics Imaging and Cardio-diagnostic Services
In-Patient Beds
Ambulatory Services (Medical Day, Minor Surgery, Urology, Endo)
Laboratory Services
Dialysis Services

14. Where will the hospital be built?
The Due Diligence work to determine where the hospital will be sited is Stage 1 Part B.
This has not yet been completed!
Multiple Options exist: McFarland Land; Existing Hospital Property
The Hospital will be sited based on the due diligence work that will be completed and that will inform everyone what is in the best interests of the community long term.

15. Future Role: Prince Edward County Memorial Hospital
The new PECMH would continue to have an important role in health care delivery in PEC by providing acute hospital care, 24 hour emergency services, diagnostic services and efficient access to the other QHC hospitals in Belleville and Trenton and to other tertiary hospitals in Kingston for treatment of more severe conditions.

16. QHC Prince Edward County Memorial Hospital: Evolving to a Integrated Future Vision
A range of integrated health care services “wrapped around the patient”…
…co-located in a new health care campus
The Board and Leadership Team remain committed to working with our partners and the LHIN to build a new hospital in Picton.

17. How much will a new Hospital Cost?
Project cost estimates are prepared and submitted for Ministry review at each stage of the development of the project.
Cost estimates are prepared by independent certified cost consultants and are expected to be accurate within +/- 5%.
Cost estimates are prepared in current $ and allowances are carried for changes in scope and inflation to the anticipated time of tender.
Following the tender, a final estimate of cost is prepared using the tendered cost of the work.
Planning estimates based on previous submission suggest the costs could be roughly $75M-$80M

18. How is a New Hospital Funded?
Ministry funding amounts are determined according to a cost share formula which provides;
90% of the hard cost of construction, not including land or facilities for revenue generation (parking, gift shop etc.).
Changes during construction are only funded where these are a result of unknowable site conditions of regulatory changes after tendering.
100% of consultant fees, with upset limits derived as a % of construction costs.
90% for ancillary costs directly related to construction, such as soil testing and air quality testing.
100% of minor non depreciable equipment, with an upset limit of 2% of construction.

19. We need your HELP!!
The community is required to provide all funds beyond the share provided by the Ministry. The local share includes:
10% of hard construction costs, including construction related ancillaries.
100% of land acquisition costs.
100% of most changes.
100% of depreciable equipment.
Any funded ancillary costs which are in excess of defined upset limits.
The requirement will be roughly $14-$18M

20. Does the Municipality have a Role?
The Municipality does not have a formal role or responsibilities to the project. As the elected representatives of the residents, council may provide significant assistance:
Provide leadership support to the Foundation to promote and assist fundraising with the general population.
Provide a commitment for a direct funding contribution
Engage with local politicians and provincial bureaucrats to promote awareness and demonstrate public support for the project.

21. How long is this going to take?
Depends who you talk too….
Typically Years
What’s really possible….

22. Next Steps
MOHLTC approval of Pre-Capital submission (anticipated in early 2017)
Completion of the Stage 1 Part B – Master Plan
Assessment of the current site
Investigation of other siting options (Greenfield Development)
Recommendation, cost estimate
Local Share Plan
Submission anticipated in mid 2017
Future work for Stages 2 through 5

23. Questions
Questions?