Doug Ford is Quietly Planning to Privatize Maintenance Services at New Hospitals in Ontario

The Ontario government’s multi-billion dollar hospital construction plan quietly includes a proposal to privatize hospital maintenance services.

According to a document from Infrastructure Ontario, the Ford government’s multi-billion hospital plan – including The Ottawa Hospital’s new Civic campus, its new Windsor/Essex regional hospital, the Mackenzie Vaughan Hospital and its addition to Toronto’s Sick Kids hospital – are all set for financing under a new P3 model.

The report notes the plan is set-up to allow a “consortia” of private companies to design, build, finance and maintain the sites – the code they’ve adopted is “progressive DBFM.”

According to the Canadian Council for Public-Private Partnerships, a DBFM model involves “the private sector designs, builds and finances an asset and provides hard facility management (hard fm) or maintenance services under a long-term agreement.”

Typically, Infrastructure Ontario notes, the province has stuck to the DFB design-finance-build p3 model – a DBFM designation would give the consortia explicit control over “maintenance.”

In 2021, Infrastructure Ontario President and CEO Michael Lindsay told a trade magazine:

“Our traditional public-private partnership models will continue to be the primary mechanism we use for project procurement and delivery … But there are several projects in our pipeline at the moment that call for approaches that are above and beyond the traditional, fixed-price, fixed-schedule approach. Whether because of their size or their complexity, those projects require new ways of working with our development partners to understand and mitigate risks.”

The government did not respond to questions from PressProgress about what “maintenance” would be under the purview of the P3 financiers.

Ontario Health Coalition Executive Director Natalie Mehra says the province’s history with private hospital financing is long and troubling.

“Usually there’s a financier and then financiers financing the financiers, there’s a property manager and a builder,” Mehra told PressProgress. “They say they find savings, but they are ridiculously expensive.”

While it is unclear what “maintenance” services the financiers will be able to control, Mehra said the province’s first P3 hospitals – the Royal Ottawa Hospital and the Brampton Civic Hospital – operate under a similar arrangement that was “bundled into the real estate deal, over a generation, all of the services of the hospital.”

That included patient support service, record-keeping, portering security, food services, and transcription. “All of that was privatized and bundled into the real estate deal for the duration of the contracts,” Mehra noted.

Registered Nurses Association of Ontario CEO Doris Grinspun says regardless of what the financiers explicitly control, they can only receive a return on their investment from the hospital’s own operations.

“RNAO does not support P3s,” Grinspun told PressProgress. “We are not in favor of investor-driven healthcare at all.”

“There is way more uncertainty from a long-run deal like this. And the consortium’s revenue’s come in unexpected ways, higher user fees, selling other services, cutting services and cheaper staffing to make up for shortfalls and so on.”