Ontarians are paying a premium of $164.9 million to replace Kingston’s mental health and rehab hospitals with a public private partnership. That’s nearly 38 per cent more than the public alternative.
The figures come from Infrastructure Ontario’s own Value for Money (VFM) document recently posted on-line.
The VFM notes the basic costs of the new hospital would have been $435.9 million had the province pursued the more traditional public procurement processes. Instead contracts were signed to build the same hospital for $600.8 million under a scheme that bundles 30-year financing and maintenance with the project’s design-and-build contract. When inflation and ongoing maintenance costs are applied to the contract, that amount rises to $901 million over the life of the agreement.
Infrastructure Ontario justifies the higher price tag by arguing the P3 actually saves $152.5 million by transferring the risk of cost overruns to the private sector. They calculate that risk at a staggering 88 per cent of the cost of the publicly-procured model – or $383.6 million on the $435.9 million price tag.
When Ontario last drafted a strategic plan for the delivery of comprehensive mental health services, the Mental Health Commission of Canada didn’t even exist.
Today we are still implementing mental health recommendations from Ontario’s Health Restructuring Commission issued in 1998. Much of the basis for that report would have come from data generated in the mid to early 1990s. That’s about 20 years ago. None of the recommendations contained in last year’s national strategy would have been in play. Nor would the health restructuring commission have been faced with the more recent and alarming projections on the rise in dementia anticipated by the Alzheimer’s Society. Nor would they have known about the links between mental illness and rising levels of economic inequality, or that Canada under the Harper government would pursue such a reckless path to the point where levels of inequality are rising faster here than most other developed nations on the planet.
That’s a long time to pursue a single plan, especially without any evaluation in-between to see how implementation has been working.
There is likely reluctance on the part of the province to do such an evaluation because it is so self-evident that it is not working. Even the all-party legislative committee looking at mental health could see the huge challenges before us and had their own lengthy list of reforms – most of which never emerged off the pages of their final 2010 report.
When David Caplan briefly sat in the Health Minister’s chair, he did promise a new 10-year mental health plan for Ontario. We never got it. Instead Health Minister Deb Matthews’ concern never extended beyond a plan for children and youth that is now in its final year of implementation. Nobody knows what comes next. They are certainly not consulting the front line workers that have to pick up the pieces of failed policy initiatives.
Part of the problem of that original 1998 plan is that the government only followed half the advice. They stuck doggedly to the bed cuts at the province’s psychiatric hospitals, but were less interested in providing equivalent scale services in the community. Nor were they interested in ensuring the services first existed before making the bed cuts.