Ontario’s network of publicly owned hospitals is in significant need of investment and repair, internal government documents reveal, with more than a quarter of all hospitals in the province listed as being in poor condition.
Global News can also reveal that five health-care buildings across Ontario also have a repair backlog so large that it would be more cost-effective to replace them entirely than pay for the necessary repairs or upgrades.
The information, which comes from a provincial database summarizing the condition of hospitals and health-care facilities in Ontario, breaks down the state of the province’s hospitals by region, showing which communities have facilities that need the most repairs.
While it’s important to note that nothing in the provincial data suggests the condition of Ontario hospitals poses a danger to patients, staff or visitors, the information provides an eye-opening view into the hospital repair backlog not typically shared with taxpayers.
Privacy and information officials with the Ministry of Health initially refused to disclose any information about the state of Ontario’s hospitals, eventually agreeing to release a redacted list after an appeal.
Global News asked the Ministry of Health to volunteer an unredacted list that named individual buildings but a spokesperson declined, citing concerns about third-party confidentiality.
Political critics of the government of Ontario Premier Doug Ford say the data should serve as a “huge wake-up call.”
Where are the hospitals that need the most maintenance?
The data obtained by Global News through freedom of information laws shows 26 per cent of the 237 health-care buildings assessed in Ontario are in poor condition. Almost half of the buildings are in fair condition and 17 per cent are in good condition.
Just over two per cent need to be replaced altogether.
While the data breaks down hospital scores by region, the Ontario government refused to divulge the condition of specific hospitals. Only two healthcare systems — The University Health Network and St. Thomas Elgin General Hospital — agreed to give Global News a view into their repair backlog.
The area with the worst average scores is the Central Local Health Integration Network (LHIN). The LHIN includes the north of Toronto, York Region and parts of Simcoe.
Five of the 10 hospitals in that area are in poor condition and one needs to be replaced entirely. Only two hospitals in the Central LHIN area are in good condition, according to the data.
Elsewhere, in the North East LHIN which includes Sudbury, Sault Ste. Marie and Timmins, two out of 32 hospitals need to be replaced.
The hospital in Ontario considered to be in the worst condition is located in the South Western LHIN, which includes London, Woodstock and Owen Sound.
A total of 12 hospital buildings in Toronto are in poor condition and one needs to be replaced. Five are in good condition, the data shows.
Known as the Facility Condition Index, the data calculates what needs to be repaired within the next two years compared with the cost of replacing the entire facility.
The rolling assessments of hospital infrastructure are performed by an independent third party for the provincial government, but are kept confidential because the government claims it would “prejudice economic interests of the hospitals.”
The index is ranked on a scale of 0 to 1 with markers in between to track the deteriorating condition of the hospital. The lower the score, the better condition the building is in.
For example, a 0.0 ranking means the hospital building is brand new and not in need of repair. Scores of 0.1 are considered good, below 0.3 is fair and above 0.3 is poor, a provincial document explains. If the cost of replacing the building is equal to repairs or cheaper, then the score will be closer to 1.0.
Rebecca Ripa, executive vice president for clinical support and performance at Toronto’s University Health Network (UHN), told Global News the scores are “a ratio between what is the repair work that you need, versus what would it cost for you to do brand new?”
Ripa said poor condition scores don’t mean buildings are dangerous for patients but that repair costs will escalate until it is eventually cheaper to start again.
The process looks at hospital buildings, not medical equipment or the beds patients are cared for in. The scores consider the age and condition of infrastructure ranging from the roof of an ambulance bay to ward doors, windows or the pipes that run behind a hospital’s walls. Other items like generators or fire alarms are also included.
A quarter of Ontario’s hospitals are assessed every four years on a rotating basis, the Ministry of Health told Global News.
Tamer El-Direaby, a professor of civil engineering at the University of Toronto, said the method used to generate the scores, which is standard practice across the industry, is far from perfect.
“When you evaluate an asset, you are basically trying to add apples and oranges and bananas and they are not in the same unit,” he said.
“So what do you do? You revert to their prices. They all have dollar values attached to them and you can just say, ‘I have two apples here, a banana here and an orange, so they add up to $20.’”
He said the issue with the scoring system is that it lacks detail and nuance.
“It doesn’t tell you if the apple is good or bad, what type, or so forth,” he continued. “It’s an old tool. It’s not bad or good, it’s old.”
A spokesperson for the Ministry of Health pointed out 72 per cent of Ontario’s hospitals are in either good or fair condition.
The spokesperson said more than half of the hospitals with the worst scores have been given funding by the Ford government after “years of neglect” by previous administrations.
Does poor condition impact patient care?
While the Ford government points out that many of its hospitals boast decent maintenance scores, critics argue that buildings in bad condition are hurting care.
Ontario NDP MPP France Gélinas said that, although poorly maintained buildings may not directly impact the care a doctor gives, they can slow down treatment. She also said even small issues with a building, like cracks in windows, can make an already stressful hospital visit much worse.
“(If) the elevators are not working again in the East Wing, you have to send patients all the way across the hall to the next set of elevators because those ones are not working anymore,” Gélinas told Global News in one example.
“Taps and toilets and stuff are not working up to par and are in need of being replaced years ago but are not, so it’s often disgusting. … This is what delayed maintenance looks like.”
Executives at UHN said the impact of aging buildings on the patient experience varies.
“I think it all depends on, frankly, how bad it looks,” UHN president and CEO Kevin Smith told Global News. “Most of the improvements aren’t radical, a coat of paint is not expensive.”
Toronto-based University Health Network has a hotline where patients can report issues with their rooms like broken blinds or showers, Smith added.
“Are we at hotel standard? We’re not at the Four Seasons standard, but we’re putting a lot more energy into that. Because this board, at this hospital, has determined that quality is the patient experience.”
Is the province paying to repair hospitals?
The Ford government said special funding is sent out to hospitals every year to help them pay to keep their buildings in good condition.
“Our government is making investments to ensure Ontario’s hospitals and community health infrastructure continue to be state-of-the-art facilities closer to home,” Jones said on July 11 at a state-of-repair funding announcement in Timmins, Ont.
Her office said that in the 2023 to 2024 year, the province will spend $208 million on repairing and upgrading hospitals and community health-care facilities. That funding comes from the Hospital Infrastructure Renewal Fund, money set aside to keep hospitals in good condition.
Smith said UHN spends about $40 million per year on its repairs. The province provides around $10 million of that number, while the rest is made up from local donations to the hospital’s fundraising arm.
The Ford government said it has increased the renewal fund by 14 per cent and will spend almost $50 billion over the next 10 years on health infrastructure.
“I think a lot of the redevelopment that you’ve already been seeing happen in the province with new buildings is based on this,” UHN’s Ripa said.
“The province has already decided priorities based on buildings that are passed their useful life and they’re doing replacements.”
Gélinas, however, said the ratings for Ontario’s current hospitals showed the government was failing to deliver on its basic responsibilities.
“The number of hospitals that are in poor shape is huge — way bigger than I expected, and not good,” the Ontario NDP critic said.
“At the provincial level, the number one responsibility is health care. Within the health care file, the biggest file is hospitals. If we cannot maintain our hospitals — keep our hospitals in a good state of maintenance — then they are failing at their job.”