Opinion

We have an obsession with putting up billion-dollar health-care palaces to prove our empathy

“Seven years from now, Calgary will have its new cancer centre. But once the new centre is open, the province will be under pressure to build the next billion-dollar health palace.” Ian Brodie, former chief of staff to prime minister Harper, on Alberta's "edifice complex.”

While compassion can be limitless, money is not

This architectural rendering shows what the new cancer centre at the northeast corner of the Foothills campus will look like. It will span more than one million square feet, including a 1,650-stall underground parking garage and a 984-linear foot elevated walkway connecting it with other buildings. (PCL Construction)

Commuters in Calgary's northwest are getting used to disruptions on 16th Avenue N.W., in front of the old Foothills hospital campus. The new Calgary Cancer Centre is going up, and will eventually replace the venerable Tom Baker Centre.

Calgary's cancer community — patients, survivors, families and medical professionals — fought hard to get the project moving. When it's finished, we will have a bigger, newer cancer centre, and we assume that means it will be better.

But it's time to rethink that.

This new cancer centre should mark the end of Alberta's "edifice complex." It should end of our obsession with putting up billion-dollar health-care palaces.

No one denies Albertans should get excellent care when they need it. But as we adjust to the new realities of having a less lucrative oil and gas sector, we have to get a new perspective on health-care delivery. We can do better by being creative, practical and focused on care, not construction.  

Building bigger

Back in the 1950s, the federal government split the cost of building new hospitals with the provinces. Provincial governments got used to spending fifty-cent dollars to consolidate health-care services in big buildings. That's how Calgary ended up with the Foothills hospital in the first place.

For decades, patients, families and medical professionals knew that life-saving care came in massive and massively expensive health-care palaces. "Big" became "good" in our minds. And this is the problem. We have developed an edifice complex about medicine. We see a building and associate it with compassion and care. Then, we spend our health-care dollars based on this false premise.

There's nothing natural about our obsession with buildings.

Politics and patient needs

The provincial government began talking up a new cancer centre for Calgary more than a decade ago. The Tom Baker Centre is aging and won't last forever.

The city's cancer community mobilized and began pushing for a new cancer megaproject in Calgary.

The new cancer centre is being built in the area marked in red in this image, at the northeast corner of the Foothills hospital campus in northwest Calgary. (Government of Alberta)

Canada's medicare programs are notorious for letting people fall through the cracks. Political priorities, professional silos and bureaucratic politics too often take priority over patient needs. The lobby campaign for the new cancer centre promised it would offer one-stop, "integrated" cancer care. That's a goal worth pursuing.

But when the quest for integrated care got caught up with our edifice complex, a focus on form displaced the concern about function. Along the way, someone decided that "integrated" care needed a $1-billion building. When oil prices rocketed to $100 a barrel, the province started rolling in dough and the price tag started to seem reasonable.

Until it didn't.

No amount of money is too much

When Jim Prentice became premier in 2014, he started warning that the province was stumbling toward a fiscal crisis. His prosaic concerns about getting better value for our money ran straight into the passionate desire to do right by cancer patients and their families. And the $1-billion price tag on the new cancer centre.

Cancer is a fear in every family and a frightful reality for too many. The terrible toll it inflicts family, friends and the neighbour's children calls forth compassionate efforts from caregivers, volunteers, researchers and medical workers. The inspiration of Terry Fox, a genuine hero, still drives a nationwide effort decades after his death.

Cancer is a scourge that calls on our common humanity. When activists in the cancer community say that no amount of money is too much money to put into cancer care, it is only human to nod in response.

Prentice showed courage, then, by challenging us to take a second look at the cancer centre project. Our economic reality was changing. Alberta's provincial spending per resident was just about the highest in Canada.

Prentice kept pointing out that, after 15 years of parsimonious government, British Columbia delivered great services to its residents — including health-care — at a far lower cost. Alberta could balance its books by becoming as careful with public dollars as B.C.

Could we do great cancer care in Calgary for less than $1 billion?

Lambasted for being insensitive

The city's other billion-dollar health megaproject, the brand new South Health Campus facility, was just opening. Prentice suggested it could house a comprehensive, integrated, best-in-class cancer treatment without the need for an expensive new building. In fact, moving cancer care to the South Health Campus would have cut the timeline for replacing the Tom Baker Centre.

But the edifice complex proved a durable foe. And it became political.

The South Health Campus began offering services in 2012 and became fully operational a year later. It has 2,400 full-time equivalent staff and 269 inpatient beds. (David Bell/CBC)

Calgary's cancer community raised a wall of opposition to Prentice. Public rallies were held, and the premier was lambasted for being insensitive.

Rachel Notley and the NDP jumped on the bandwagon. They championed the cause of cancer patients and, not coincidentally, the interests of unionized hospital and construction workers. More surprisingly, Wildrose, the party promising to balance the budget, joined the pile on — promising to find the money if elected.

New hospital buildings make great campaign promises, and ribbon-cuttings are feel good photo ops for the politicians who write the cheques. The payoff in actually running a good medical service doesn't come with a photo op.

When the Notley government took office, it could have cured the edifice complex, and freed AHS to focus on getting health care right, rather than managing a massive construction project. But there was now a political and social objective to delivering the $1-billion building first, and worrying about care later.

Other options

Any building can house a cancer centre, and as the economic downturn led to massive layoffs in Calgary, millions of square feet of office space emptied out in our city's core. Outside downtown, industrial space has flooded the market.

The timing was perfect to set aside plans for a special purpose building and instead turn any one of dozens of existing sites into a world-class treatment facility with a low-cost 20- or 40-year lease.

But the choice was made. The deed is done.

Premier Rachel Notley, Dr. Francois Belanger, chief medical officer for Alberta Health Services, Will Morlidge, cancer centre patient and family advisor, with daughter Virginia, Infrastructure Minister Sandra Jansen and Health Minister Sarah Hoffman break ground on the Calgary Cancer Centre on Nov. 3, 2017. (Government of Alberta)

The contract for the new Calgary Cancer Centre building turned out to be $1.1 billion, with a total project cost of $1.4 billion.

Walls do not equal treatments. Atriums do not equal physicians. Putting patient needs first will prove a lot harder than erecting walls and a roof.

Seven years from now, Calgary will have its new cancer centre. With good management it might just end up providing the integrated, one-stop care that its proponents hoped for. But once the new centre is open, the province will be under pressure to build the next billion-dollar health palace.

The road ahead

The main Foothills building is aging. So is the Lougheed. So is the Rockyview.

Hospitals don't last forever, and no one will want to say "no" to a billion-dollar centre for integrated cardiac care. Or addictions treatment. Or geriatric medicine. Perhaps they should.

The main building of the Foothills Medical Centre opened in 1966. It's the largest hospital in Alberta. (Alberta Health Services)

Health spending is the biggest item in the provincial government's budget. It accounts for around 40 per cent of all provincial spending, and if we do nothing, it's heading higher.

No one can freeze provincial spending without doing something to rein in health spending.

That means someone is going to have to come up with a better plan for delivering excellent cardiac care, addictions treatment and geriatric medicine. One that doesn't involve more and more billion-dollar health palaces.

We need a cure for our edifice complex.


Calgary: The Road Ahead is CBC Calgary's special focus on our city as we build the city we want — the city we need. It's the place for possibilities. A marketplace of ideas. Have an idea? Email us at: calgarytheroadahead@cbc.ca

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About the Author

Ian Brodie

Ian Brodie is a political scientist at the University of Calgary and was the chief of staff to former prime minister Stephen Harper. His next book, At the Centre of Government, will be published by McGill-Queen’s University Press in May.