Hamilton Health Sciences will stop operating St. Peter's Hospital and McMaster University Medical Centre under a 20-year plan approved by its board.

"What we're going to do with those facilities at this particular point in time is uncertain," said Norm Col, chair of the board of directors.

The plan also calls for Hamilton patients to go to an expanded Grimsby hospital for day surgery.

The HHS proposal now going to the Local Health Integration Network and the province suggests MUMC would most likely be given back to McMaster University in the next 10 to 12 years.

"This will permit the current MUMC facility to be transitioned back to the Faculty of Health Sciences, McMaster University, who own the site for future growth in academic and research activities."

St. Peter's would be "repurposed" within 10 years "for other community health related activities and health/wellness partners."

The case for cutting ties with SPH and MUMC is contained in the board report approved June 23, which HHS has not made readily available to the public.

The hospital network stopped posting board agendas and reports on its website a year ago with no explanation. The Spectator was given a copy five days after requesting it.

The report makes it clear that Hamilton General Hospital and Juravinski Hospital and Cancer Centre will be the only two hospital sites operated by HHS in its vision of the future.

"HHS identified opportunities to reduce the number of large acute care hospital sites it operates in Hamilton by relocating services currently provided at MUMC and SPH to HGH and JHCC."

The two remaining hospitals would be redeveloped along with Grimsby's West Lincoln Memorial Hospital.

A "substantial portion of day surgery" would move out of Hamilton to Grimsby.

"This recommendation will take pressure off the very busy operating rooms in Hamilton with complex, in-patient surgeries, and puts less complex day surgery in a more appropriate ambulatory environment," states the proposal.

Grimsby would also have an emergency department, do low-risk births and have a community medicine program.

A new hospital for women and children would be built near HGH and become part of its campus within the next 10 years.

A big part of the plan is creating community clinics or other ways to access services in neighbourhoods — particularly those that need it most.

Future patients could even connect virtually with HHS.

"HHS anticipates that reducing the number of operating sites would offer significant opportunities for efficiencies," states the report by Kelly Campbell, vice-president of corporate services and capital development, and Aaron Levo, vice-president communications and public affairs.

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Some of the efficiencies come from being able to merge services like pharmacy, diagnostics and laboratories. Some result simply from having to provide services in fewer buildings.

Fewer sites also could "improve patient experience through the continuum of care," suggests the report.

MUMC is specifically targeted because the site is owned by McMaster University, with HHS having a space-sharing agreement.

"Given the ownership structure, HHS has limited ability to expand or redevelop the 45- year-old site to meet future needs, particularly additional space for the growing demands of the McMaster Children's Hospital. Additionally, HHS is currently responsible for all maintenance and infrastructure renewal at the MUMC site, with costs recovered from McMaster University according to their respective space utilization of the site," states the report.

In addition, it's difficult for HHS to maintain an intensive care unit for birthing moms at MUMC.

"Moving the Women's Reproductive Health program to a new building at the HGH site would allow the program to utilize the services of the HGH adult Intensive Care Unit, instead of the current model where a small and relatively expensive Women's ICU is required at MUMC."

CEO Rob MacIsaac says HHS will try to find "new opportunities" for the St. Peter's and MUMC sites instead of seeing them close altogether.

"I think it would be wrong to say 100 per cent the vision is that there won't be anything left on either of the sites."

The next steps are to take the plan to the LHIN and the province.

"The best way to think about it is that you start off in a very broad circle and you keep narrowing in until you have your final plan," said MacIsaac. "We'll keep going in concentric circles until we arrive at an answer that is good for us and acceptable to the LHIN and to the province. Where we stand today might not look like exactly where we end up at the end of the process. I think we've got a vision we can be proud of. … But there's still lots of work left."

Report to Board of Directors